Provider Demographics
NPI:1285013979
Name:CLIFFORD, THIERA DANYAL (PHD)
Entity Type:Individual
Prefix:
First Name:THIERA
Middle Name:DANYAL
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6645
Mailing Address - Country:US
Mailing Address - Phone:313-316-0227
Mailing Address - Fax:
Practice Address - Street 1:1771 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6645
Practice Address - Country:US
Practice Address - Phone:313-800-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014742101YP2500X
101YP2500X
MI6301019322103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1720685464Medicaid