Provider Demographics
NPI:1942357934
Name:MILLER-CLARKSON, JEAN R (PHD, LP, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:R
Last Name:MILLER-CLARKSON
Suffix:
Gender:F
Credentials:PHD, LP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9456
Mailing Address - Country:US
Mailing Address - Phone:734-854-7061
Mailing Address - Fax:734-854-7061
Practice Address - Street 1:6530 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9456
Practice Address - Country:US
Practice Address - Phone:734-854-7061
Practice Address - Fax:734-854-7061
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007455101YM0800X, 101YP2500X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional