Provider Demographics
NPI:1871126292
Name:LIPTAK, DANIEL JOHN (MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:LIPTAK
Suffix:
Gender:M
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 BANISTER LN STE 200C
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8077
Mailing Address - Country:US
Mailing Address - Phone:512-328-7222
Mailing Address - Fax:512-367-5668
Practice Address - Street 1:4005 BANISTER LN STE 200C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8077
Practice Address - Country:US
Practice Address - Phone:512-328-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026494163W00000X, 363LP0808X
OH465421163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse