Provider Demographics
NPI:1629755319
Name:CLIFT, GREGORY LEE (QMHP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:CLIFT
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61690 PETTIGREW RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2422
Mailing Address - Country:US
Mailing Address - Phone:541-617-0377
Mailing Address - Fax:
Practice Address - Street 1:61690 PETTIGREW RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2422
Practice Address - Country:US
Practice Address - Phone:541-617-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist