Healthcare Provider Details

I. General information

NPI: 1558158816
Provider Name (Legal Business Name): MR. MATTHEW CHARLES ZIPPRIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 MARIAN LN
ROSENBERG TX
77471-8610
US

IV. Provider business mailing address

3219 MARIAN LN
ROSENBERG TX
77471-8610
US

V. Phone/Fax

Practice location:
  • Phone: 281-796-8657
  • Fax:
Mailing address:
  • Phone: 281-796-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number69545
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: