Healthcare Provider Details

I. General information

NPI: 1891946554
Provider Name (Legal Business Name): JENNY LYNN CHIEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY LYNN MOULTON

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CASCADE WEST PKWY SE STE 240
GRAND RAPIDS MI
49546-2166
US

IV. Provider business mailing address

500 CASCADE WEST PKWY SE STE 240
GRAND RAPIDS MI
49546-2166
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-9000
  • Fax: 616-432-3059
Mailing address:
  • Phone: 616-591-9000
  • Fax: 616-432-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH5541
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: