Individual
CRYSTAL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12319 HIGHLAND RD STE 501, HARTLAND, MI 48353-2946
(810) 991-1211
Mailing address
12319 HIGHLAND RD STE 501, HARTLAND, MI 48353-2946
(810) 991-1211
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
03/30/2016
Last updated
11/01/2023
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