| Karen Noelle Clark, Phd, Pllc | |
|
26677 W 12 Mile Rd Southfield MI 48034-1514 | |
| (248) 909-2203 | |
| Not Available |
| Full Name | Karen Noelle Clark, Phd, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 26677 W 12 Mile Rd, Southfield, Michigan |
| Authorized Official Name and Position | Karen Noelle Clark (INDEPENDENT PSYCHOLOGIST) |
| Authorized Official Contact | 2489092203 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Karen Noelle Clark, Phd, Pllc Po Box 2206 Southfield MI 48037-2206 Ph: (248) 909-2203 | Karen Noelle Clark, Phd, Pllc 26677 W 12 Mile Rd Southfield MI 48034-1514 Ph: (248) 909-2203 |
| NPI Number | 1922565670 |
|---|---|
| Provider Enumeration Date | 02/28/2019 |
| Last Update Date | 02/28/2019 |
| Medicare PECOS PAC ID | 9436492188 |
|---|---|
| Medicare Enrollment ID | O20190520002601 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922565670 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Karen N Clark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023057924 PECOS PAC ID: 5294733275 Enrollment ID: I20061130000089 |
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