Provider Demographics
NPI:1811476187
Name:TIPTON, MANDY LYNN (PLPC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:TIPTON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60377 ORION RD
Mailing Address - Street 2:
Mailing Address - City:GREEN CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63545-2229
Mailing Address - Country:US
Mailing Address - Phone:660-292-0246
Mailing Address - Fax:417-944-1440
Practice Address - Street 1:1108 E PATTERSON ST STE 5
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4002
Practice Address - Country:US
Practice Address - Phone:660-951-2197
Practice Address - Fax:417-944-1440
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018020715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional