Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301005403 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301005403 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301005403 | MI |
N | 103G00000X | Clinical Psychologist | 6301005403 | MI |
N | 103TC0700X | Clinical Psychologist | 6301005403 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301005403 | MI |
NPI | 1285802660 |
---|---|
Provider Name | Dr. Clifford F Furgison |
First Address | Troy, MI 48084-4900 |
Second Address | Troy, MI 48084-4900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2008 |
Last Update Date | 19/02/2008 |