Provider Demographics
NPI:1245129063
Name:TIPTON, GERALYN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:GERALYN
Middle Name:
Last Name:TIPTON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:GIGI
Other - Middle Name:
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:726 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:WALLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77485-8106
Mailing Address - Country:US
Mailing Address - Phone:832-265-7045
Mailing Address - Fax:
Practice Address - Street 1:726 SURREY LN
Practice Address - Street 2:
Practice Address - City:WALLIS
Practice Address - State:TX
Practice Address - Zip Code:77485-8106
Practice Address - Country:US
Practice Address - Phone:832-265-7045
Practice Address - Fax:832-265-7045
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty