Provider Demographics
NPI:1255562666
Name:CRIPPEN, EULA MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:EULA
Middle Name:MARIE
Last Name:CRIPPEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EULA
Other - Middle Name:MARIE
Other - Last Name:CRIPPEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:41075 BIDARKI DR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-9261
Mailing Address - Country:US
Mailing Address - Phone:907-617-6671
Mailing Address - Fax:810-255-4722
Practice Address - Street 1:41075 BIDARKI DR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-9261
Practice Address - Country:US
Practice Address - Phone:907-617-6671
Practice Address - Fax:810-255-4722
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSY-PSY-LIC-4503103TC0700X
AK106430103TC0700X
AK731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1255562666Medicaid