Healthcare Provider Details

I. General information

NPI: 1376455170
Provider Name (Legal Business Name): MICHAEL NEYLON CLARK LLPC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ORLEANS BLVD
COLDWATER MI
49036-1784
US

IV. Provider business mailing address

300 ORLEANS BLVD
COLDWATER MI
49036-1784
US

V. Phone/Fax

Practice location:
  • Phone: 517-227-5234
  • Fax: 517-279-8172
Mailing address:
  • Phone: 517-227-5234
  • Fax: 517-279-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025055
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: