1851836530 NPI number — DR. CHARITY ELAINE CLIFFORD LMFT

Table of content: DR. CHARITY ELAINE CLIFFORD LMFT (NPI 1851836530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851836530 NPI number — DR. CHARITY ELAINE CLIFFORD LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLIFFORD
Provider First Name:
CHARITY
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEMP
Provider Other First Name:
CHARITY
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851836530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66282-3115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-488-2178
Provider Business Mailing Address Fax Number:
913-273-6643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 S 18TH ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102-5642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-502-8492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2591 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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