Provider Demographics
NPI:1730944331
Name:LIPSCOMB, CHAUNCEY LYDELL
Entity type:Individual
Prefix:MR
First Name:CHAUNCEY
Middle Name:LYDELL
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 HICKORY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6825
Mailing Address - Country:US
Mailing Address - Phone:317-222-9458
Mailing Address - Fax:
Practice Address - Street 1:5130 HICKORY LAKE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-6825
Practice Address - Country:US
Practice Address - Phone:317-222-9458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral