Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | LF00001514 | WA |
NPI | 1093774077 |
---|---|
Provider Name | Mr. Michael Timothy Clifford |
First Address | Everett, WA 98201-3523 |
Second Address | Everett, WA 98201-3523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 08/07/2007 |