Provider Demographics
NPI:1659988798
Name:WESTPHAL CLIFTON, GAEL LYN (RBT)
Entity Type:Individual
Prefix:MS
First Name:GAEL
Middle Name:LYN
Last Name:WESTPHAL CLIFTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 8TH ST NW APT 1309
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4571
Mailing Address - Country:US
Mailing Address - Phone:614-323-5025
Mailing Address - Fax:
Practice Address - Street 1:95 8TH ST NW APT 1309
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4571
Practice Address - Country:US
Practice Address - Phone:614-323-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GA381925642106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician