Provider Demographics
NPI:1104678044
Name:CLIFTON, BEANCA BROOKE (BCBA)
Entity type:Individual
Prefix:
First Name:BEANCA
Middle Name:BROOKE
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2199 BURNS HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOBELVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37097-4618
Mailing Address - Country:US
Mailing Address - Phone:931-306-3676
Mailing Address - Fax:
Practice Address - Street 1:2286 JONES CREEK RD
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-4213
Practice Address - Country:US
Practice Address - Phone:615-422-7233
Practice Address - Fax:209-265-1059
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-24-72133103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst