Provider Demographics
NPI:1861889404
Name:TIPAN, JENNIFER (MA,)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:TIPAN
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 NORMA DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-2433
Mailing Address - Country:US
Mailing Address - Phone:562-972-5506
Mailing Address - Fax:
Practice Address - Street 1:401 S TUSTIN ST BLDG B
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2550
Practice Address - Country:US
Practice Address - Phone:714-244-4322
Practice Address - Fax:714-244-4330
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional