Provider Demographics
NPI:1114934940
Name:CLARK, MARY FRANZEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:FRANZEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:41820 6 MILE RD
Mailing Address - Street 2:104
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2763
Mailing Address - Country:US
Mailing Address - Phone:248-349-3131
Mailing Address - Fax:248-349-3232
Practice Address - Street 1:41820 6 MILE RD
Practice Address - Street 2:104
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-2763
Practice Address - Country:US
Practice Address - Phone:248-349-3131
Practice Address - Fax:248-349-3232
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005828103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy