Basic Information
| Provider Information | |||||||||
| NPI: | 1356413652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIPTON | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | SHANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3554 W CHRISTINE CIR APT 3 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928044640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149952705 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 W COMMONWEALTH AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928321810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144477000 | ||||||||
| FaxNumber: | 7144477003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.