Healthcare Provider Details

I. General information

NPI: 1740352863
Provider Name (Legal Business Name): DAVID N LIPPITT PH.D., L.M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12805 HIGHWAY 55 SUITE 211
PLYMOUTH MN
55441-3859
US

IV. Provider business mailing address

12805 HIGHWAY 55 SUITE 211
PLYMOUTH MN
55441-3859
US

V. Phone/Fax

Practice location:
  • Phone: 763-550-9005
  • Fax: 763-559-2118
Mailing address:
  • Phone: 763-550-9005
  • Fax: 763-559-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: