Provider Demographics
NPI:1801632161
Name:OTTS, CLIFFORD WILLIAM
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:WILLIAM
Last Name:OTTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JOE RAMSEY BLVD E
Mailing Address - Street 2:UNIT 4 STE C
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401
Mailing Address - Country:US
Mailing Address - Phone:817-600-9301
Mailing Address - Fax:
Practice Address - Street 1:3900 JOE RAMSEY BLVD E
Practice Address - Street 2:UNIT 4 STE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:817-600-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor