Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY 9536 | FL |
N | 103T00000X | Psychologist | PY 9536 | FL |
N | 103TA0700X | Adult Development & Aging Psychologist | PY 9536 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY 9536 | FL |
Y | 103G00000X | Clinical Psychologist | PY 9536 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 9536 | FL |
N | 103TF0000X | Family Psychologist | PY 9536 | FL |
N | 103TF0200X | Forensic Psychologist | PY 9536 | FL |
N | 103TH0100X | Health Service | PY 9536 | FL |
NPI | 1356548853 |
---|---|
Provider Name | Dr. Clifton Mclesky Ables |
First Address | Avon Park, FL 33825-7211 |
Second Address | Avon Park, FL 33825-7211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 31/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9536 | FLORIDA DEPARTMENT OF HEALTH (01) | FL |