Provider Demographics
NPI:1831104678
Name:ALPHA PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:ALPHA PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-349-3131
Mailing Address - Street 1:41820 6 MILE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2771
Mailing Address - Country:US
Mailing Address - Phone:248-349-3131
Mailing Address - Fax:248-349-3232
Practice Address - Street 1:41820 6 MILE RD STE 104
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-2771
Practice Address - Country:US
Practice Address - Phone:248-349-3131
Practice Address - Fax:248-349-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty