Provider Demographics
NPI:1215718903
Name:CLAWSON, HAILIE (MA, LLC)
Entity type:Individual
Prefix:
First Name:HAILIE
Middle Name:
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:MA, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 OLDE HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-8200
Mailing Address - Country:US
Mailing Address - Phone:313-655-2142
Mailing Address - Fax:
Practice Address - Street 1:9333 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3386
Practice Address - Country:US
Practice Address - Phone:449-406-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional