Healthcare Provider Details

I. General information

NPI: 1215642210
Provider Name (Legal Business Name): CARLY PERCY MA, TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 S LINDEN RD STE B
FLINT MI
48532-3457
US

IV. Provider business mailing address

816 SILVER CREEK RD
MARQUETTE MI
49855-8970
US

V. Phone/Fax

Practice location:
  • Phone: 810-407-7403
  • Fax:
Mailing address:
  • Phone: 480-215-6586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6351004875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: