Provider Demographics
NPI:1912346032
Name:LIPPERT, GREG (MA, MHC, CSAC)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:LIPPERT
Suffix:
Gender:M
Credentials:MA, MHC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 N HESS ST # 104
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9827
Mailing Address - Country:US
Mailing Address - Phone:808-852-9142
Mailing Address - Fax:
Practice Address - Street 1:250 NORTHWEST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2971
Practice Address - Country:US
Practice Address - Phone:208-929-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health