| Doctor Name: | DR. MARY FRANZEN CLARK |
| NPI Number: | 1114934940 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.D. |
| License Number: | 6301005828 |
| Business Practice Address: | 41820 6 Mile Rd 104 Northville, MI - 481682763 |
| Business Phone Number: | 2483493131 |
| Business Fax Number: | 2483493232 |
| Mailing Address: | 41820 6 Mile Rd, 104 NORTHVILLE |
| State: | MI |
| Postal Code: | 481682763 |
| Phone Number: | 2483493131 |
| Fax Number: | 2483493232 |
| NPI Enumeration Date: | 08/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TP2701X |
| License Number: | 6301005828 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Group Psychotherapy |
| Taxonomy Definition: | |