Healthcare Provider Details

I. General information

NPI: 1225987175
Provider Name (Legal Business Name): KATY CLARK LMSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MILLER AVE STE 147
ANN ARBOR MI
48103-3373
US

IV. Provider business mailing address

310 MILLER AVE STE 147
ANN ARBOR MI
48103-3373
US

V. Phone/Fax

Practice location:
  • Phone: 734-210-0116
  • Fax: 734-590-2106
Mailing address:
  • Phone: 734-210-0116
  • Fax: 734-590-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE CLARK
Title or Position: OWNER
Credential: LMSW
Phone: 734-210-0116