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General NPI Number Information
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NPI Number | 1396984100
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Entity Type | Organization
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Legal Business Name | THE LIPPERT HOME
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 3545 BRIGHTON WAY
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City | RENO
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State | NV
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Zip | 89509-3871
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Country | US
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Telephone | 775-324-5277
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Fax | 775-322-4212
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Provider Business Mailing Address
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Address Line | 3545 BRIGHTON WAY
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City | RENO
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State | NV
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Zip | 89509-3871
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Country | US
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Telephone | 775-324-5277
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Fax | 775-322-4212
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JAMES G. LIPPERT
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Credential | PH.D.
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Telephone | 775-324-5277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PY0106
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License Number State | NV
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