Provider Demographics
NPI:1467538439
Name:CLIFFORD, SUE DIANE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:DIANE
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24511 ARROW TREE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3273
Mailing Address - Country:US
Mailing Address - Phone:210-887-2122
Mailing Address - Fax:
Practice Address - Street 1:24511 ARROW TREE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3273
Practice Address - Country:US
Practice Address - Phone:210-887-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157656301Medicaid
TX276802OtherMHN PROVIDER #
TX2099978OtherFIRST HEALTH PROVIDER #
TX6418LCOtherBCBS PROVIDER #
TX2170669OtherCIGNA PROVIDER #
TX14495OtherCOMMUNITY FIRST PROVIDER
TX486262000OtherAETNA PROVIDER #