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General NPI Number Information
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NPI Number | 1578615696
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Entity Type | Individual
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Provider Name | ROBERT M. TRIPP M.S.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1600 JOHN ADAMS PKWY 102
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4300
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Country | US
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Telephone | 208-529-5276
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Fax | 208-529-6506
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Provider Business Mailing Address
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Address Line | 3865 TAYLORVIEW LN
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City | AMMON
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State | ID
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Zip | 83406-8145
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Country | US
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Telephone | 208-552-1850
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-1037
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License Number State | ID
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