Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LH 60143083 | WA |
NPI | 1003002569 |
---|---|
Provider Name | Kenneth E Clifton |
First Address | Jblm, WA 98431 |
Second Address | Tacoma, WA 98431-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 13/05/2020 |