Provider Demographics
NPI:1568864809
Name:REGINA TIPPETS PLLC
Entity Type:Organization
Organization Name:REGINA TIPPETS PLLC
Other - Org Name:RCT COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-450-8813
Mailing Address - Street 1:505 NYGREEN ST
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-9421
Mailing Address - Country:US
Mailing Address - Phone:801-450-8813
Mailing Address - Fax:
Practice Address - Street 1:505 NYGREEN ST
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-9421
Practice Address - Country:US
Practice Address - Phone:801-450-8813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT289022-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health