Provider Demographics
NPI:1508958992
Name:SIPPOLA, TIMOTHY (PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SIPPOLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 COMMERCIAL ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-3093
Mailing Address - Country:US
Mailing Address - Phone:620-481-0100
Mailing Address - Fax:
Practice Address - Street 1:702 COMMERCIAL ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-3093
Practice Address - Country:US
Practice Address - Phone:620-342-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00523103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48-1212043OtherCENTURY HEALTH SOLUTIONS
KS48-1212043OtherUNITED BEHAVIORAL HEALTH
KS48-1212043OtherFEDERATED INSURANCE
KS48-1212043OtherAETNA 60054
KS48-1212043OtherBANKER'S LIFE & CASUALTY
KSP00285242OtherRAIL ROAD MEDICARE
KS119025OtherBC & BS OF KS
KS48-1212043OtherHEALTH PARTNERS OF KS
KS48-1212043OtherASSURANT HEALTH/FORTIS
KS48-1212043OtherCIGNA
KS48-1212043OtherFMH BENEFIT SERVICES
KS48-1212043OtherTRIWEST
KS48-1212043OtherCOOPERATIVE BENEFIT ADMIN
KS48-1212043OtherCENTRAL STATES - SE & SW
KS48-1212043OtherFISERV HEALTH
KS48-1212043OtherVALUE OPTIONS
KS48-1212043OtherPREFERRED HEALTH SYSTEMS
KS48-1212043OtherBANKER'S LIFE & CASUALTY
KS48-1212043OtherCOOPERATIVE BENEFIT ADMIN
KS48-1212043OtherHEALTH PARTNERS OF KS