Healthcare Provider Details

I. General information

NPI: 1922362979
Provider Name (Legal Business Name): ROXANNA LYNN TIPTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 AIR DEPOT BLVD
TINKER AFB OK
73145-8716
US

IV. Provider business mailing address

7050 AIR DEPOT BLVD
TINKER AFB OK
73145-8716
US

V. Phone/Fax

Practice location:
  • Phone: 405-582-6603
  • Fax:
Mailing address:
  • Phone: 405-582-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4884
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: