Provider Demographics
NPI:1821208745
Name:PIPPENGER, GARY MICHAEL (LPC, CEAP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:PIPPENGER
Suffix:
Gender:M
Credentials:LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:826 MARY MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7601
Mailing Address - Country:US
Mailing Address - Phone:314-993-1750
Mailing Address - Fax:314-842-6124
Practice Address - Street 1:9735 LANDMARK PARKWAY DR
Practice Address - Street 2:SUITE 17
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1646
Practice Address - Country:US
Practice Address - Phone:314-842-6223
Practice Address - Fax:314-842-6124
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional