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General NPI Number Information
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NPI Number | 1871531400
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Entity Type | Organization
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Legal Business Name | CLARK&ASSOCIATES PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 16250 NORTHLAND DR, SUITE 245 16250 NORTHLAND DRIVE, SUITE 245
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5227
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Country | US
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Telephone | 248-559-2673
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Fax | 248-559-7944
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Provider Business Mailing Address
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Address Line | 16250 NORTHLAND DR, SUITE 245 16250 NORTHLAND DRIVE, SUITE 245
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5227
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Country | US
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Telephone | 248-559-2673
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Fax | 248-559-7944
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. AURELIA FOSTER
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Credential |
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Telephone | 248-559-2673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6301001882
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | MI
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