Provider Demographics
NPI:1891510509
Name:LIPPART, MARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:LIPPART
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 1:611 S HIGHWAY 78 STE 122
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4111
Mailing Address - Country:US
Mailing Address - Phone:972-442-0605
Mailing Address - Fax:
Practice Address - Street 1:611 S HIGHWAY 78 STE 122
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4111
Practice Address - Country:US
Practice Address - Phone:972-442-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39666103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist