Provider Demographics
NPI:1689822710
Name:CLIFFORD, TINA M (LMFT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 SEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5249
Mailing Address - Country:US
Mailing Address - Phone:831-818-5005
Mailing Address - Fax:
Practice Address - Street 1:740 FRONT ST
Practice Address - Street 2:SUIT 360
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4535
Practice Address - Country:US
Practice Address - Phone:831-818-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist