Basic Information
Provider Information
NPI: 1720055957
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIPPS
FirstName: DONNA
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1025 SUDDEN VLY
Address2:  
City: BELLINGHAM
State: WA
PostalCode: 982294827
CountryCode: US
TelephoneNumber: 3607153391
FaxNumber:  
Practice Location
Address1: 3645 E MCLEOD RD
Address2:  
City: BELLINGHAM
State: WA
PostalCode: 982268700
CountryCode: US
TelephoneNumber: 3606762220
FaxNumber: 3606767750
Other Information
ProviderEnumerationDate: 03/07/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XRC00023737WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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