Provider Demographics
NPI:1801204458
Name:TIPPING, DANIELLE (PSYD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:TIPPING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 HACTON CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8402
Mailing Address - Country:US
Mailing Address - Phone:630-923-5215
Mailing Address - Fax:
Practice Address - Street 1:2662 HACTON CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8402
Practice Address - Country:US
Practice Address - Phone:630-923-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2550103T00000X
IL071009824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist