Provider Demographics
NPI:1447660725
Name:SIPP, TAMARA MONIC
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MONIC
Last Name:SIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15623
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-5623
Mailing Address - Country:US
Mailing Address - Phone:858-652-1211
Mailing Address - Fax:503-328-8094
Practice Address - Street 1:1584 NE 8TH ST STE 200
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5746
Practice Address - Country:US
Practice Address - Phone:971-421-8696
Practice Address - Fax:503-328-8094
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9023101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor