Provider Demographics
NPI:1679375182
Name:TIPTON, SHARON (LIAC-S)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:TIPTON
Suffix:
Gender:
Credentials:LIAC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1503
Mailing Address - Country:US
Mailing Address - Phone:214-744-5956
Mailing Address - Fax:
Practice Address - Street 1:1019 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1503
Practice Address - Country:US
Practice Address - Phone:214-744-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLIAC-155354101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty