Provider Demographics
NPI:1619564374
Name:STIPP, SIERRA (LCSW)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:STIPP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5829
Mailing Address - Country:US
Mailing Address - Phone:870-970-8150
Mailing Address - Fax:
Practice Address - Street 1:276 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5829
Practice Address - Country:US
Practice Address - Phone:870-970-8150
Practice Address - Fax:888-977-2956
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10254-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR259618795Medicaid