Provider Demographics
NPI:1669599577
Name:TIPTON, PAULA JEAN (LCPC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:TIPTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EXECUTIVE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7509
Mailing Address - Country:US
Mailing Address - Phone:847-566-3136
Mailing Address - Fax:
Practice Address - Street 1:10 EXECUTIVE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-7509
Practice Address - Country:US
Practice Address - Phone:847-566-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional