Provider Demographics
NPI:1710103387
Name:PIPPIN, RUSSELL DUANE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:DUANE
Last Name:PIPPIN
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 1:535 TWAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-2643
Mailing Address - Country:US
Mailing Address - Phone:559-269-6630
Mailing Address - Fax:
Practice Address - Street 1:55 SHAW AVE STE 115
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3819
Practice Address - Country:US
Practice Address - Phone:559-825-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist