Provider Demographics
NPI:1003237959
Name:CLORE, MOLLY M (MS)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:M
Last Name:CLORE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:M
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:720 W WACKERLY ST
Mailing Address - Street 2:STE 11
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2769
Mailing Address - Country:US
Mailing Address - Phone:989-832-2165
Mailing Address - Fax:
Practice Address - Street 1:720 W. WACKERLY
Practice Address - Street 2:SUITE 11
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-832-2165
Practice Address - Fax:989-839-4376
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015334103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist