Provider Demographics
NPI:1871816041
Name:CLARK, DEBRA STRILER (MA, PSYS, LLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:STRILER
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA, PSYS, LLP
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:LIN
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:71 WALNUT
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2073
Mailing Address - Country:US
Mailing Address - Phone:248-650-1180
Mailing Address - Fax:
Practice Address - Street 1:71 WALNUT
Practice Address - Street 2:SUITE 109
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2073
Practice Address - Country:US
Practice Address - Phone:248-650-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005896103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical