Provider Demographics
NPI:1730367905
Name:TRIPP, JAMES ERIC (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERIC
Last Name:TRIPP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:ERIC
Other - Last Name:TRIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:29401 WILDBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-6932
Mailing Address - Country:US
Mailing Address - Phone:313-456-1053
Mailing Address - Fax:313-456-1579
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:333
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4537
Practice Address - Country:US
Practice Address - Phone:313-456-1053
Practice Address - Fax:313-456-1579
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005954103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical