Provider Demographics
NPI:1558831933
Name:PIETRANTONIO, KIPP RYAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIPP
Middle Name:RYAN
Last Name:PIETRANTONIO
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 1:6363 FOREST PARK RD 7TH FLOOR STE 749
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9121
Mailing Address - Country:US
Mailing Address - Phone:214-645-8500
Mailing Address - Fax:214-648-3775
Practice Address - Street 1:6363 FOREST PARK RD, 7TH FLOOR
Practice Address - Street 2:STE. 749
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9121
Practice Address - Country:US
Practice Address - Phone:214-645-8500
Practice Address - Fax:214-648-3775
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist