Provider Demographics
NPI:1104195650
Name:CYPERT, CLIFTON FOREST (MHR, LPC)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:FOREST
Last Name:CYPERT
Suffix:
Gender:M
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 VISTA VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-1189
Mailing Address - Country:US
Mailing Address - Phone:405-222-7898
Mailing Address - Fax:405-513-5970
Practice Address - Street 1:4575 VISTA VALLEY LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-1189
Practice Address - Country:US
Practice Address - Phone:405-222-7898
Practice Address - Fax:405-513-5970
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
103K00000X
OK6437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200414750BMedicaid