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General NPI Number Information
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NPI Number | 1417196346
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Entity Type | Individual
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Provider Name | CLIFFORD WALTER CHURCHILL JR. LMHC
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Gender | Male
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 8625 SE ALABAMA PL CLIFFCHURCHILLJR@GMAIL.COM
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City | HOBE SOUND
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State | FL
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Zip | 33455
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Country | US
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Telephone | 772-485-8828
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Fax | 856-441-8421
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Provider Business Mailing Address
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Address Line | 2440 SE FEDERAL HWY SUITE L
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City | STUART
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State | FL
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Zip | 34994-4531
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Country | US
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Telephone | 772-485-8828
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Fax | 856-441-8421
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH10577
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License Number State | FL
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