Provider Demographics
NPI:1326413873
Name:CLIFFORD, LAWRENCE ZACHARY (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ZACHARY
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:ZACK
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:4515 LASATER TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1642
Mailing Address - Country:US
Mailing Address - Phone:805-328-8322
Mailing Address - Fax:
Practice Address - Street 1:4515 LASATER TRL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1642
Practice Address - Country:US
Practice Address - Phone:805-328-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-19681103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst