Provider Demographics
NPI:1225360662
Name:CLARK, KERRIE (LPC)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KERRIE
Other - Middle Name:
Other - Last Name:KRAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:5005 PLAINFIELD AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-279-3869
Mailing Address - Fax:616-608-4657
Practice Address - Street 1:5005 PLAINFIELD AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-279-3869
Practice Address - Fax:616-608-4657
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional