Healthcare Provider Details

I. General information

NPI: 1730816067
Provider Name (Legal Business Name): ADAM EDWARD TRIPP RSPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11910 GREENVILLE AVE STE 511
DALLAS TX
75243-9388
US

IV. Provider business mailing address

11910 GREENVILLE AVE STE 511
DALLAS TX
75243-9388
US

V. Phone/Fax

Practice location:
  • Phone: 214-937-9180
  • Fax: 214-253-8017
Mailing address:
  • Phone: 214-937-9180
  • Fax: 214-253-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1246-0521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: