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General NPI Number Information
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NPI Number | 1558090969
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Entity Type | Organization
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Legal Business Name | KRISTIE CLARK, PLLC
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 5090 STATE ST STE B102
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City | SAGINAW
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State | MI
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Zip | 48603-3778
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Country | US
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Telephone | 989-430-6553
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Fax | 989-355-0438
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Provider Business Mailing Address
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Address Line | 12375 WHISPER RIDGE DR
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City | FREELAND
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State | MI
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Zip | 48623-9500
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Country | US
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Telephone | 989-430-6553
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Fax | 989-355-0438
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. KRISTIE CLARK
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Credential |
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Telephone | 989-430-6553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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