Provider Demographics
NPI:1730816067
Name:TRIPP, ADAM EDWARD (RSPS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:EDWARD
Last Name:TRIPP
Suffix:
Gender:M
Credentials:RSPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11910 GREENVILLE AVE STE 511
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9388
Mailing Address - Country:US
Mailing Address - Phone:214-937-9180
Mailing Address - Fax:214-253-8017
Practice Address - Street 1:11910 GREENVILLE AVE STE 511
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9388
Practice Address - Country:US
Practice Address - Phone:214-937-9180
Practice Address - Fax:214-253-8017
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 171M00000X, 172V00000X
TX1246-0521175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1246-0521OtherTEXAS CERTIFICATION BOARD