Provider Demographics
NPI:1831979384
Name:STIPEK, TIMOTHY P (BA, MSSA, LISW-SUPV)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:P
Last Name:STIPEK
Suffix:
Gender:M
Credentials:BA, MSSA, LISW-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 GLENSIDE LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3122
Mailing Address - Country:US
Mailing Address - Phone:440-915-7547
Mailing Address - Fax:216-721-0940
Practice Address - Street 1:7319 GLENSIDE LN
Practice Address - Street 2:
Practice Address - City:OLMSTED TWP
Practice Address - State:OH
Practice Address - Zip Code:44138-3122
Practice Address - Country:US
Practice Address - Phone:440-915-7547
Practice Address - Fax:216-721-0940
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0005463-SUPV171M00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator