Individual
JACOB TIPTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7310 WOODWARD AVE, DETROIT, MI 48202-3165
(313) 896-1444
Mailing address
8106 E JEFFERSON AVE APT D307, DETROIT, MI 48214-8055
(616) 378-0036
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6362009753
MI
106S00000X
Behavior Technician
—
MI
106S00000X
Behavior Technician
—
—
247200000X
Other Technician
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2018
Last updated
08/10/2023
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