Provider Demographics
NPI:1609824523
Name:CLIFTON, CAROL (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CLIFTON
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 1:10365 SE SUNNYSIDE RD STE 315
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5748
Mailing Address - Country:US
Mailing Address - Phone:503-724-1722
Mailing Address - Fax:503-855-3055
Practice Address - Street 1:10365 SE SUNNYSIDE RD STE 315
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5748
Practice Address - Country:US
Practice Address - Phone:503-724-1722
Practice Address - Fax:503-855-3055
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCHGRMedicare ID - Type Unspecified