Provider Demographics
NPI:1730658113
Name:TIPPINS, PATRICIA JEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JEAN
Last Name:TIPPINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:TIPPINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4379 EXCURSION DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3659
Mailing Address - Country:US
Mailing Address - Phone:719-291-5189
Mailing Address - Fax:719-291-5189
Practice Address - Street 1:4379 EXCURSION DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3659
Practice Address - Country:US
Practice Address - Phone:719-291-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2104101YP2500X
CO5470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional