Individual
DR. JULIANNE S. LARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4021 W MAIN ST, SUITE 100, KALAMAZOO, MI 49006-3706
(269) 384-6055
(269) 384-6056
Mailing address
4021 W MAIN ST, SUITE 100, KALAMAZOO, MI 49006-3706
(269) 384-6055
(269) 384-6056
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
6301008518
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301008518
PSYCHOLOGY LICENSE
MI
01
—
68-0-C9-4634-0
BLUE CROSS BLUE SLD PIN
MI
Enumeration date
12/28/2006
Last updated
12/10/2013
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