Provider Demographics
NPI:1275055279
Name:SUSAN CLIFFORD
Entity Type:Organization
Organization Name:SUSAN CLIFFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-706-9322
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:JOSEPH
Mailing Address - State:OR
Mailing Address - Zip Code:97846-0197
Mailing Address - Country:US
Mailing Address - Phone:541-706-9322
Mailing Address - Fax:833-510-0436
Practice Address - Street 1:1001 SW EMKAY DR STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3663
Practice Address - Country:US
Practice Address - Phone:541-706-9322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2693261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821133802OtherNPPES