Basic Information
| Provider Information | |||||||||
| NPI: | 1508914169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIPTON | ||||||||
| FirstName: | LORINE | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 2 BOX 501 | ||||||||
| Address2: | |||||||||
| City: | TYRONE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166869725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147429872 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 E CHESTNUT AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166015215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149430414 | ||||||||
| FaxNumber: | 8149436198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | X | Behavioral Health & Social Service Providers | Social Worker | 101Y00000X | X | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 0014679050001 | 05 | PA | MEDICAID |