Provider Demographics
NPI:1770110355
Name:HURNDON, CLIFFORD JOSEPH (PHD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:JOSEPH
Last Name:HURNDON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 CLASSIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2801
Mailing Address - Country:US
Mailing Address - Phone:863-984-6961
Mailing Address - Fax:
Practice Address - Street 1:301 3RD ST NW STE 212
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4094
Practice Address - Country:US
Practice Address - Phone:863-325-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8587103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling