Provider Demographics
NPI:1598568719
Name:NORMAN, CLIFFORD BERNARD JR (MS, NCC, LMHC)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:BERNARD
Last Name:NORMAN
Suffix:JR
Gender:
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 BRADY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-3825
Mailing Address - Country:US
Mailing Address - Phone:727-768-9176
Mailing Address - Fax:
Practice Address - Street 1:615 N 18TH ST STE 106
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3413
Practice Address - Country:US
Practice Address - Phone:765-205-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004605A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health