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General NPI Number Information
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NPI Number | 1245837319
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Entity Type | Individual
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Provider Name | KATHLEEN TRIPP LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 1301 BARBARA JORDAN BLVD STE 401
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City | AUSTIN
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State | TX
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Zip | 78723-3078
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Country | US
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Telephone | 512-628-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 241 MAPLEWOOD S
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City | KYLE
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State | TX
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Zip | 78640-5268
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Country | US
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Telephone | 512-620-1530
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 59048
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License Number State | TX
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