Provider Demographics
NPI:1851720338
Name:TRIPPLETT, MARIAN (LLMSW, MED)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:TRIPPLETT
Suffix:
Gender:F
Credentials:LLMSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 S CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-1618
Mailing Address - Country:US
Mailing Address - Phone:269-325-8084
Mailing Address - Fax:
Practice Address - Street 1:818 S CRYSTAL AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-1618
Practice Address - Country:US
Practice Address - Phone:269-325-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093528104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker