Provider Demographics
NPI:1629573233
Name:CLIFTON, THERESA KAY (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:KAY
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3242
Mailing Address - Country:US
Mailing Address - Phone:270-777-4490
Mailing Address - Fax:866-824-4022
Practice Address - Street 1:2204 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3242
Practice Address - Country:US
Practice Address - Phone:270-777-4490
Practice Address - Fax:866-824-4022
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2520221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical