Provider Demographics
NPI:1679641518
Name:LIPSCOMB, RODERICK D (CM)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:D
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:CM
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Other - Credentials:
Mailing Address - Street 1:8040 BAY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1690
Mailing Address - Country:US
Mailing Address - Phone:317-842-5787
Mailing Address - Fax:317-466-1710
Practice Address - Street 1:TRANSITIONAL ASSISTANCE SVC., 6100 N. KEYSTONE AVENUE
Practice Address - Street 2:SUITE 237
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2426
Practice Address - Country:US
Practice Address - Phone:317-466-1740
Practice Address - Fax:317-466-1710
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health