Active NPI
Lisa Clark, LLP
- Psychologist
- Grand Rapids, MI
National Provider Identifier
1639590813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301012462
- Practice address
- 5005 Plainfield Ave NE Ste 100
Grand Rapids, MI 49525-9747 - Phone
- (616) 279-3869
- Fax
- (616) 608-4657
- NPI assigned
- Dec 14, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301012462 | MI | Primary |
Addresses
Primary practice location
5005 Plainfield Ave NE Ste 100
Grand Rapids, MI 49525-9747
Mailing address
5005 Plainfield Ave NE Ste 100
Grand Rapids, MI 49525-2087
Phone (616) 821-7095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301012462 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785196800000",
"number": "1639590813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5005 PLAINFIELD AVE NE STE 100",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495252087",
"telephone_number": "616-821-7095",
"fax_number": "616-608-4657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5005 PLAINFIELD AVE NE STE 100",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495259747",
"telephone_number": "616-279-3869",
"fax_number": "616-608-4657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LISA",
"credential": "LLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-14",
"last_updated": "2026-07-28",
"certification_date": "2026-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301012462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.