Thelma Staley Clark, CRC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401008178 Issued in MI

Practice address

9329 Telegraph Rd
Redford, MI 48239-1260

Phone

(313) 450-4500

Fax

(313) 450-4514

NPI assigned

Mar 17, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Thelma Staley Clark Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lincoln Behavioral Services

  • Family Medicine Physician
  • Redford, MI
  • NPI 1356987762
  NPD (past)
• Lincoln Behavioral Services

  • Psychiatry Physician
  • Redford, MI
  • NPI 1669451944
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1346633187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9329 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482391260",
            "telephone_number": "313-450-4500",
            "fax_number": "313-450-4514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9329 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482391260",
            "telephone_number": "313-450-4500",
            "fax_number": "313-450-4514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "THELMA",
        "middle_name": "STALEY",
        "credential": "CRC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-17",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "00049452",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401008178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THELMA",
            "last_name": "CLARK",
            "middle_name": "STALEY",
            "prefix": "DR.",
            "credential": "CRC, LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Adrian Chestnut
• Caritta Christian, MA,LLP
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• Markita Denise Close, BS, CCHW
• Bonita Burton Cobb, LMSW
• Chiara Coburn-Dees
• Carmen Cochran, PSYD, DLLP, LPC

• Professional Counselor in Redford, MI
• Providers in Redford, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.