Provider Demographics
NPI:1558483610
Name:TIPTON, MARCELLE MIR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARCELLE
Middle Name:MIR
Last Name:TIPTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 CHAMBOARD LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-3250
Mailing Address - Country:US
Mailing Address - Phone:713-686-6566
Mailing Address - Fax:713-926-3323
Practice Address - Street 1:5001 NAVIGATION BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-1019
Practice Address - Country:US
Practice Address - Phone:713-926-1849
Practice Address - Fax:713-926-3323
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical