Healthcare Provider Details

I. General information

NPI: 1407702293
Provider Name (Legal Business Name): LUCI CLARK THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CAMBRIDGE CT STE 219
AUBURN HILLS MI
48326-2514
US

IV. Provider business mailing address

2701 CAMBRIDGE CT STE 219
AUBURN HILLS MI
48326-2514
US

V. Phone/Fax

Practice location:
  • Phone: 248-289-0327
  • Fax:
Mailing address:
  • Phone: 248-289-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LUCILE CLARK
Title or Position: THERAPIST
Credential: MA LPC DTLLP
Phone: 541-890-6941