Healthcare Provider Details

I. General information

NPI: 1710103387
Provider Name (Legal Business Name): RUSSELL DUANE PIPPIN L.M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SHAW AVE STE 115
CLOVIS CA
93612-3819
US

IV. Provider business mailing address

535 TWAIN AVE
CLOVIS CA
93612-2643
US

V. Phone/Fax

Practice location:
  • Phone: 559-825-1324
  • Fax:
Mailing address:
  • Phone: 559-269-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: