MEDICARE: MICHELLE KIPPER LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	100451	CA

General Provider Information

NPI Number	:	1588289508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KIPPER LMFT

Provider Business Mailing Address
First Line	:	591 REDWOOD HWY FRONTAGE RD STE 5260
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-3019
Country	:	US
Telephone Number	:	415-339-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	591 REDWOOD HWY FRONTAGE RD STE 5260
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-3019
Country	:	US
Telephone Number	:	415-339-8001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	06/15/2020

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