Provider Demographics
NPI:1285802660
Name:FURGISON, CLIFFORD F (PHD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:F
Last Name:FURGISON
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 1:755 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4900
Mailing Address - Country:US
Mailing Address - Phone:248-362-1314
Mailing Address - Fax:
Practice Address - Street 1:755 W BIG BEAVER RD
Practice Address - Street 2:SUITE 414
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4900
Practice Address - Country:US
Practice Address - Phone:248-362-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005403103G00000X, 103TA0400X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF 33003Medicare PIN