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General NPI Number Information
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NPI Number | 1487792834
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Entity Type | Individual
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Provider Name | MICHAEL S ZACK MS LLP
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 6549 TOWN CENTER DR STE A
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City | CLARKSTON
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State | MI
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Zip | 48346-4824
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Country | US
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Telephone | 248-620-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 6549 TOWN CENTER DR STE A
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City | CLARKSTON
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State | MI
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Zip | 48346-4824
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Country | US
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Telephone | 248-620-6400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301010522
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802064603
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6361002828
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License Number State | MI
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