Basic Information
| Provider Information | |||||||||
| NPI: | 1225496136 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUZANNE CLECK PSYD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28345 BECK RD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | WIXOM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483934733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484211553 | ||||||||
| FaxNumber: | 8558561414 | ||||||||
| Practice Location | |||||||||
| Address1: | 28345 BECK RD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | WIXOM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483934733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484211553 | ||||||||
| FaxNumber: | 8558561414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | CLECK | ||||||||
| AuthorizedOfficialFirstName: | SUZANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHOTHERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 2484211553 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD LMSW LLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801085951 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.