Provider Demographics
NPI:1164682795
Name:CLOR, LINDA ROSE (LMSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ROSE
Last Name:CLOR
Suffix:
Gender:F
Credentials:LMSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42657 GARFIELD RD
Mailing Address - Street 2:STE 213
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-228-8838
Mailing Address - Fax:586-228-0813
Practice Address - Street 1:42657 GARFIELD RD
Practice Address - Street 2:STE 213
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-228-8838
Practice Address - Fax:586-228-0813
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801035885104100000X
MI4101005701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000892750Medicare PIN