Healthcare Provider Details

I. General information

NPI: 1457644478
Provider Name (Legal Business Name): ELDON CLIFFORD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HILLTOP DR
BUFFALO WY
82834-9644
US

IV. Provider business mailing address

5 HILLTOP DR
BUFFALO WY
82834-9644
US

V. Phone/Fax

Practice location:
  • Phone: 307-620-5245
  • Fax:
Mailing address:
  • Phone: 307-620-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1173
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number488
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: