Healthcare Provider Details

I. General information

NPI: 1699374876
Provider Name (Legal Business Name): THOMAS LIPPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 FAIRGROVE AVE
HAMILTON OH
45011-1930
US

IV. Provider business mailing address

1910 FAIRGROVE AVE
HAMILTON OH
45011-1930
US

V. Phone/Fax

Practice location:
  • Phone: 513-795-7557
  • Fax: 513-297-7577
Mailing address:
  • Phone: 513-795-7557
  • Fax: 513-297-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.183573
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: