Provider Demographics
NPI:1558477844
Name:LIPPINS, RANDALL BRIAN
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:BRIAN
Last Name:LIPPINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22464
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-0464
Mailing Address - Country:US
Mailing Address - Phone:916-391-5016
Mailing Address - Fax:
Practice Address - Street 1:8912 VOLUNTEER LN STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3224
Practice Address - Country:US
Practice Address - Phone:916-368-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist