Provider Demographics
NPI:1134429624
Name:CLIFFORD, KATHLEEN CAROL (MFT INTERN, NCC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CAROL
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:MFT INTERN, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1450
Mailing Address - Country:US
Mailing Address - Phone:775-420-0366
Mailing Address - Fax:
Practice Address - Street 1:556 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1450
Practice Address - Country:US
Practice Address - Phone:775-420-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health