Individual
MATTHEW DAVID AYERS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D., FLP
Contact information
Practice address
7150 KALAMAZOO AVE SE, STE C, CALEDONIA, MI 49316-9126
(616) 690-5437
(616) 825-6225
Mailing address
7150 KALAMAZOO AVE SE, STE C, CALEDONIA, MI 49316-9126
(616) 690-5437
(616) 825-6225
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301013305
MI
103TC0700X
Clinical Psychologist
6301013305
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0897749
BLUE CROSS BLUE SHIELD
MI
01
—
D16189090
MEDICARE
MI
Enumeration date
08/17/2006
Last updated
01/16/2019
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