| Clark Institute Psychology Pllc | |
|
7150 Kalamazoo Ave Se Suite C Caledonia MI 49316 | |
| (616) 219-0159 | |
| (616) 219-0124 |
| Full Name | Clark Institute Psychology Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 7150 Kalamazoo Ave Se, Caledonia, Michigan |
| Authorized Official Name and Position | Matthew Clark (OWNER) |
| Authorized Official Contact | 6162045589 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Institute Psychology Pllc 7150 Kalamazoo Ave Se Suite C Caledonia MI 49316 Ph: (616) 219-0159 | Clark Institute Psychology Pllc 7150 Kalamazoo Ave Se Suite C Caledonia MI 49316 Ph: (616) 219-0159 |
| NPI Number | 1508339524 |
|---|---|
| Provider Enumeration Date | 01/03/2019 |
| Last Update Date | 01/17/2019 |
| Medicare PECOS PAC ID | 9436495298 |
|---|---|
| Medicare Enrollment ID | O20190115003185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508339524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Matthew D Clark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811001126 PECOS PAC ID: 8921004615 Enrollment ID: I20061020000391 |
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