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MS. MARY JOSEPHINE CLARK M.A., L.P.C.
NPI 1063482578
Counselor - Professional in Kentwood, MI

Active since January 25, 2006
4835 EASTERN AVE SE, SUITE 102, KENTWOOD, MI 49508(616) 262-9749(866) 416-7581 Get Directions Write a Review

NPPES record last updated: May 2, 2017. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ms. Mary Josephine Clark M.a., L.p.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. MARY JOSEPHINE CLARK M.A., L.P.C. (NPI 1063482578) is an individual professional provider in Kentwood, Michigan, licensed in Michigan (6401005964) and active in the NPI registry since January 2006.

NPPES Registry Identity

NPI1063482578
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameMS. MARY JOSEPHINE CLARKCredential: M.A., L.P.C.
Location Address4835 EASTERN AVE SE, SUITE 102Kentwood, MI 49508-4729
Mailing Address1680 44th St Se Unit 8074Grand Rapids, MI 49518-5005 · (616) 262-9749 · Fax (866) 416-7581
Phone(616) 262-9749
Fax(866) 416-7581
Sole ProprietorYes
Enumeration DateJanuary 25, 2006
Last NPPES UpdateMay 2, 2017
✔ NPI 1063482578 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MI · 6401005964
4835 EASTERN AVE SE, Kentwood, MI 49508
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Clark's NPI number?

The NPI number for Mary Clark is 1063482578. It was assigned to this individual provider in the NPPES registry on January 25, 2006.

Where is Mary Clark located?

Mary Clark practices at 4835 Eastern Ave SE Suite 102, Kentwood, MI 49508. The listed phone number is (616) 262-9749.

What is Mary Clark's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

When was this NPI record last updated?

The NPPES record for Mary Clark was last updated on May 2, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.