Provider Demographics
NPI:1225274020
Name:CLARK DUNNILL, COURTNEY (PSYD LLP)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:CLARK DUNNILL
Suffix:
Gender:F
Credentials:PSYD LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E BELTLINE AVE SE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7673
Mailing Address - Country:US
Mailing Address - Phone:616-287-2206
Mailing Address - Fax:
Practice Address - Street 1:2025 E. BELTLINE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7673
Practice Address - Country:US
Practice Address - Phone:616-287-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014090103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical