Provider Demographics
NPI:1578615696
Name:TRIPP, ROBERT M (MS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:TRIPP
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3865 TAYLORVIEW LN
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-8145
Mailing Address - Country:US
Mailing Address - Phone:208-552-1850
Mailing Address - Fax:
Practice Address - Street 1:1600 JOHN ADAMS PKWY
Practice Address - Street 2:102
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4300
Practice Address - Country:US
Practice Address - Phone:208-529-5276
Practice Address - Fax:208-529-6506
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-1037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional