Provider Demographics
NPI:1780326728
Name:TIPPEN, SANDRA M (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:TIPPEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GARYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70051-3410
Mailing Address - Country:US
Mailing Address - Phone:504-239-6081
Mailing Address - Fax:
Practice Address - Street 1:249 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:GARYVILLE
Practice Address - State:LA
Practice Address - Zip Code:70051-3410
Practice Address - Country:US
Practice Address - Phone:504-239-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
91271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical