Provider Demographics
NPI:1871702845
Name:TIPPIT, PAMELA LOMAX
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LOMAX
Last Name:TIPPIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:LOMAX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LPC
Mailing Address - Street 1:112 PINEDA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-8088
Mailing Address - Country:US
Mailing Address - Phone:256-655-6464
Mailing Address - Fax:
Practice Address - Street 1:112 PINEDA DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-8088
Practice Address - Country:US
Practice Address - Phone:256-655-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AL2745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health