Clark, Frederick

Clark, Frederick is an individual health care provider with primary practice located at 41521 W 11 Mile Rd , Novi MI 48375-1803. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Other Service Providers / Case Manager/Care Coordinator. Other Service Providers / Case Manager/Care Coordinator is his primary health care specialty. Clark, Frederick can be contacted via phone (804) 244-6728.

Contact Information

Primary practice address
41521 W 11 Mile Rd Novi MI 48375-1803
Phone: (804) 244-6728
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X
Other Service Providers / Case Manager/Care Coordinator 171M00000X

Profile Details

NPI number 1922512607
LBN Legal business name Clark, Frederick
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2017
Last updated Apr 16th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922512607 NPPES
Ohio MEDICAID 2910854

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