Healthcare Provider Details

I. General information

NPI: 1336281344
Provider Name (Legal Business Name): GERALD DOUGLAS LUCK M. A,, L. L. P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43740 N GROESBECK HWY
CLINTON TOWNSHIP MI
48036-1139
US

IV. Provider business mailing address

9410 MCDOUGALL
HAMTRAMCK MI
48212
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-7629
  • Fax: 586-469-7662
Mailing address:
  • Phone: 313-874-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number6301005113
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301005113
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301005113
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301005113
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number6301005113
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6301005113
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301005113
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6301005113
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: