Provider Demographics
NPI:1376788067
Name:TIPPEY-HERRICK, PAMELA JO (LCPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JO
Last Name:TIPPEY-HERRICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16249 E RED MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61542-9273
Mailing Address - Country:US
Mailing Address - Phone:209-547-2117
Mailing Address - Fax:
Practice Address - Street 1:16249 E RED MAPLE LN
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:IL
Practice Address - Zip Code:61542-9273
Practice Address - Country:US
Practice Address - Phone:209-547-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health