=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689769184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLIFTON EARL CHARLES M.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 MURPHY RD STE B1344
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-440-0827
-----------------------------------------------------
Fax | 832-415-2472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1415 KENNEWICK CT
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77479-5428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-721-7524
-----------------------------------------------------
Fax | 832-415-2472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 63569
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------