Provider Demographics
NPI:1760675649
Name:TIPTON, GLORIA S (EDD, MSW)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:S
Last Name:TIPTON
Suffix:
Gender:F
Credentials:EDD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4916
Mailing Address - Country:US
Mailing Address - Phone:850-249-1524
Mailing Address - Fax:850-215-5657
Practice Address - Street 1:215 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4916
Practice Address - Country:US
Practice Address - Phone:850-249-1524
Practice Address - Fax:850-215-5658
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW37821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical