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NPI Code Detail

MEDICARE: FAITH MYRANDA TIPTON LCSW

MEDICARE: FAITH MYRANDA TIPTON LCSW
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
11041C0700XClinical Social WorkerSWB-2023-0329NM
2104100000XSocial WorkerSWB-2023-0329NM

General Provider Information

NPI Number : 1700473378
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAITH MYRANDA TIPTON LCSW
Provider Business Mailing Address
First Line : 4201 CARLISLE BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87107-4808
Country : US
Telephone Number : 505-717-1332
Fax Number :
Provider Business Practice Location Address
First Line : 4201 CARLISLE BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87107-4808
Country : US
Telephone Number : 505-717-1332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2020
Last Update Date : 06/13/2026

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Directions to “ FAITH MYRANDA TIPTON LCSW” Practice Location

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