Basic Information
| Provider Information | |||||||||
| NPI: | 1639378524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIPPEL | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674012353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858250541 | ||||||||
| FaxNumber: | 7858250062 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 ELMHURST BLVD | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858236322 | ||||||||
| FaxNumber: | 7858233109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 236 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 200434040A | 05 | KS | MEDICAID |