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NPI Code Detail

MEDICARE: MR. ADAM LEE SIPES

MEDICARE: MR. ADAM LEE SIPES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor5796CA

General Provider Information

NPI Number : 1245523125
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ADAM LEE SIPES
Provider Business Mailing Address
First Line : 1133 MENDOCINO WAY
Second Line :
City : REDLANDS
State : CA
Zip : 92374-4975
Country : US
Telephone Number : 909-730-5561
Fax Number :
Provider Business Practice Location Address
First Line : 20 W LUGONIA AVE
Second Line :
City : REDLANDS
State : CA
Zip : 92374-2234
Country : US
Telephone Number : 909-307-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2011
Last Update Date : 06/04/2024

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