Provider Demographics
NPI:1770854978
Name:LIPMAN, LAURETTE (LPCC)
Entity Type:Individual
Prefix:
First Name:LAURETTE
Middle Name:
Last Name:LIPMAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 1/2 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2925
Mailing Address - Country:US
Mailing Address - Phone:650-360-2211
Mailing Address - Fax:
Practice Address - Street 1:133 1/2 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2925
Practice Address - Country:US
Practice Address - Phone:650-360-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7364101YM0800X
MI6401013286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health