Provider Demographics
NPI:1336388271
Name:MLINARCIK, JOHN DERYL (MS, MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DERYL
Last Name:MLINARCIK
Suffix:
Gender:M
Credentials:MS, MA, PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:40462 BEECHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3417
Mailing Address - Country:US
Mailing Address - Phone:734-542-6969
Mailing Address - Fax:734-542-6967
Practice Address - Street 1:141 N. CENTER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1479
Practice Address - Country:US
Practice Address - Phone:734-542-6969
Practice Address - Fax:734-542-6967
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010153711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical