Provider Demographics
NPI:1417196346
Name:CHURCHILL, CLIFFORD WALTER JR (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:WALTER
Last Name:CHURCHILL
Suffix:JR
Gender:M
Credentials:LMHC
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Mailing Address - Street 1:2440 SE FEDERAL HWY
Mailing Address - Street 2:SUITE L
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4531
Mailing Address - Country:US
Mailing Address - Phone:772-485-8828
Mailing Address - Fax:856-441-8421
Practice Address - Street 1:8625 SE ALABAMA PL
Practice Address - Street 2:CLIFFCHURCHILLJR@GMAIL.COM
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455
Practice Address - Country:US
Practice Address - Phone:772-485-8828
Practice Address - Fax:856-441-8421
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2013-01-03
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Provider Licenses
StateLicense IDTaxonomies
FLMH10577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health