Provider Demographics
NPI:1679500243
Name:FRANK, MARY (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FRANK
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5675 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1033
Mailing Address - Country:US
Mailing Address - Phone:269-429-7727
Mailing Address - Fax:269-429-5754
Practice Address - Street 1:5675 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1033
Practice Address - Country:US
Practice Address - Phone:269-429-7727
Practice Address - Fax:269-429-5754
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301008271103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI61-30054OtherPHP ID#