Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301015334 | MI |
Y | 103T00000X | Psychologist | 6301015334 | MI |
NPI | 1003237959 |
---|---|
Provider Name | Miss Molly M. Clore |
First Address | Midland, MI 48640-2769 |
Second Address | Midland, MI 48640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2013 |
Last Update Date | 13/08/2018 |