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NPI Code Detail

MEDICARE: MR. GERALD HARVEY SHIPP MA, LMFT

MEDICARE: MR. GERALD HARVEY SHIPP MA, LMFT
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
1106H00000XMarriage & Family TherapistT0329OR

General Provider Information

NPI Number : 1932207040
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GERALD HARVEY SHIPP MA, LMFT
Provider Business Mailing Address
First Line : 14584 SE BONNIE WAY
Second Line :
City : MILWAUKIE
State : OR
Zip : 97267-2225
Country : US
Telephone Number : 503-723-7130
Fax Number :
Provider Business Practice Location Address
First Line : 7455 SW BEVELAND ST
Second Line :
City : TIGARD
State : OR
Zip : 97223-8610
Country : US
Telephone Number : 503-624-2600
Fax Number : 503-624-7752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/08/2007

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