Healthcare Provider Details

I. General information

NPI: 1831104678
Provider Name (Legal Business Name): ALPHA PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41820 6 MILE RD STE 104
NORTHVILLE MI
48168-2771
US

IV. Provider business mailing address

41820 6 MILE RD STE 104
NORTHVILLE MI
48168-2771
US

V. Phone/Fax

Practice location:
  • Phone: 248-349-3131
  • Fax: 248-349-3232
Mailing address:
  • Phone: 248-349-3131
  • Fax: 248-349-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. THOMAS R CLARK
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 248-349-3131