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General NPI Number Information
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NPI Number | 1194904029
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Entity Type | Organization
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Legal Business Name | CAROLYN VAN CLEAVE, ED.D. PC
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Dates
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Enumeration Date | 10/27/2007
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 901 CANAL ST
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City | MT PLEASANT
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State | MI
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Zip | 48858-3304
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Country | US
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Telephone | 989-772-6241
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Fax | 989-772-8009
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Provider Business Mailing Address
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Address Line | 901 CANAL ST
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City | MT PLEASANT
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State | MI
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Zip | 48858-3304
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Country | US
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Telephone | 989-772-6241
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Fax | 989-772-8009
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROLYN VAN CLEAVE
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Credential | ED.D.
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Telephone | 989-772-6241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301002777
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License Number State | MI
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