Healthcare Provider Details

I. General information

NPI: 1639378524
Provider Name (Legal Business Name): CARL E DIPPEL LCMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NE RICE RD
LEES SUMMIT MO
64086-5849
US

IV. Provider business mailing address

1555 NE RICE RD
LEES SUMMIT MO
64086-5849
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-3069
  • Fax:
Mailing address:
  • Phone: 816-347-3069
  • Fax: 785-825-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number236
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2023003157
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: