Provider Demographics
NPI:1073334421
Name:CLIFT, ELIZABETH (PRS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CLIFT
Suffix:
Gender:F
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MARION PIKE STE 1
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638-2958
Mailing Address - Country:US
Mailing Address - Phone:740-237-4981
Mailing Address - Fax:877-325-2816
Practice Address - Street 1:323 MARION PIKE STE 1
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-2958
Practice Address - Country:US
Practice Address - Phone:740-237-4981
Practice Address - Fax:877-325-2816
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005543175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0072883Medicaid