Provider Demographics
NPI:1588849640
Name:CLIFTON, BROOKE LEANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEANNE
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LEANNE
Other - Last Name:MOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:MI
Mailing Address - Zip Code:49074-0094
Mailing Address - Country:US
Mailing Address - Phone:833-342-4552
Mailing Address - Fax:
Practice Address - Street 1:156 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1102
Practice Address - Country:US
Practice Address - Phone:833-342-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010885861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801088586Medicare PIN