Provider Demographics
NPI:1336668698
Name:CLAYSTONE CLINICAL ASSOCIATES PLC
Entity Type:Organization
Organization Name:CLAYSTONE CLINICAL ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-949-7460
Mailing Address - Street 1:2040 RAYBROOK ST SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7718
Mailing Address - Country:US
Mailing Address - Phone:616-949-7460
Mailing Address - Fax:616-949-3018
Practice Address - Street 1:2040 RAYBROOK ST SE STE 300
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7718
Practice Address - Country:US
Practice Address - Phone:616-949-7460
Practice Address - Fax:616-949-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty