Provider Demographics
NPI:1184818544
Name:HEPBURN, CLIFFORD (MFT)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:HEPBURN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 WHITE WATER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2123
Mailing Address - Country:US
Mailing Address - Phone:530-247-1330
Mailing Address - Fax:
Practice Address - Street 1:1424 WHITE WATER CIRCLE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003
Practice Address - Country:US
Practice Address - Phone:530-247-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist