Organization
DR. JULIANNE S. LARK, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIANNE S. LARK PH.D. (OWNER)
(269) 384-6055
Entity
Organization
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
103T00000X
Psychologist
Primary
6301008518
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68-0-C9-4634-0
BLUE CROSS BLUE SHIELD PIN
MI
Enumeration date
12/12/2013
Last updated
12/12/2013
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