Provider Demographics
NPI:1598777013
Name:TIPPS, KATHY L (PHD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:TIPPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 TURTLE CREEK BLVD
Mailing Address - Street 2:SUITE 1026
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5426
Mailing Address - Country:US
Mailing Address - Phone:214-522-0931
Mailing Address - Fax:214-522-2507
Practice Address - Street 1:3131 TURTLE CREEK BLVD
Practice Address - Street 2:SUITE 1026
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5426
Practice Address - Country:US
Practice Address - Phone:214-522-0931
Practice Address - Fax:214-522-2507
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-5443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U95POtherBCBS
TX00U95POtherBCBS
TXS25249Medicare UPIN