Healthcare Provider Details

I. General information

NPI: 1528955150
Provider Name (Legal Business Name): JENNIFER CLIFTON MC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W CHANDLER BLVD STE 120
CHANDLER AZ
85224-6100
US

IV. Provider business mailing address

1955 W BASELINE RD STE 113-388
MESA AZ
85202-9003
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-2250
  • Fax:
Mailing address:
  • Phone: 602-688-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-23965
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: