Provider Demographics
NPI:1922565670
Name:KAREN NOELLE CLARK, PHD, PLLC
Entity Type:Organization
Organization Name:KAREN NOELLE CLARK, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-909-2203
Mailing Address - Street 1:PO BOX 2206
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-2206
Mailing Address - Country:US
Mailing Address - Phone:248-909-2203
Mailing Address - Fax:
Practice Address - Street 1:26677 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1514
Practice Address - Country:US
Practice Address - Phone:248-909-2203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty