Provider Demographics
NPI:1477673572
Name:TIPTON, GREGORY WAYNE (MA, MDIV, NCC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:WAYNE
Last Name:TIPTON
Suffix:
Gender:M
Credentials:MA, MDIV, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4013
Mailing Address - Country:US
Mailing Address - Phone:303-399-9988
Mailing Address - Fax:303-399-9977
Practice Address - Street 1:131 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4013
Practice Address - Country:US
Practice Address - Phone:303-399-9988
Practice Address - Fax:303-399-9977
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health