Individual
MR. DOUGLAS J. PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
2314 MONROE ST, DEARBORN, MI 48124-3010
(313) 565-5937
Mailing address
2314 MONROE ST, DEARBORN, MI 48124-3010
(313) 565-5937
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301011777
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680H216560
BLUE CARE NETWORK
MI
Enumeration date
03/24/2006
Last updated
05/19/2014
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