Provider Demographics
NPI:1770931685
Name:TIPTON, KATHRYN LEE (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:TIPTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 MONTROSE BLVD
Mailing Address - Street 2:SUITE 480
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5471
Mailing Address - Country:US
Mailing Address - Phone:713-259-9049
Mailing Address - Fax:
Practice Address - Street 1:4203 MONTROSE BLVD
Practice Address - Street 2:SUITE 480
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5471
Practice Address - Country:US
Practice Address - Phone:713-259-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional