Provider Demographics
NPI:1568787687
Name:CRIPPEN, JOHN CARL (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARL
Last Name:CRIPPEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 PACIFIC AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2266
Mailing Address - Country:US
Mailing Address - Phone:503-601-5400
Mailing Address - Fax:503-601-5410
Practice Address - Street 1:4110 PACIFIC AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2266
Practice Address - Country:US
Practice Address - Phone:503-601-5400
Practice Address - Fax:503-601-5410
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0692106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist