Healthcare Provider Details

I. General information

NPI: 1093774077
Provider Name (Legal Business Name): MICHAEL TIMOTHY CLIFFORD L.M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 ROCKEFELLER AVE
EVERETT WA
98201-3523
US

IV. Provider business mailing address

2702 ROCKEFELLER AVE
EVERETT WA
98201-3523
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-2955
  • Fax:
Mailing address:
  • Phone: 425-258-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLF00001514
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: