Provider Demographics
NPI:1902305444
Name:BUHL, CLIFFORD JAMES (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:JAMES
Last Name:BUHL
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 WESCOTT TRL APT 201
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2299
Mailing Address - Country:US
Mailing Address - Phone:507-469-9077
Mailing Address - Fax:
Practice Address - Street 1:890 WESCOTT TRL APT 201
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2299
Practice Address - Country:US
Practice Address - Phone:507-469-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical