Provider Demographics
NPI:1336267053
Name:TIPPINS, CARL ALLEN (PHD LMHC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ALLEN
Last Name:TIPPINS
Suffix:
Gender:M
Credentials:PHD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 WESTLAKE AVE N STE 316
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2707
Mailing Address - Country:US
Mailing Address - Phone:206-325-9920
Mailing Address - Fax:296-325-2191
Practice Address - Street 1:1818 WESTLAKE AVE N STE 316
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2707
Practice Address - Country:US
Practice Address - Phone:206-325-9920
Practice Address - Fax:296-325-2191
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
510504644OtherTIN