Healthcare Provider Details

I. General information

NPI: 1881308666
Provider Name (Legal Business Name): KIMBERLY LICHON-TUFER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HALL ST SW STE 185A
GRAND RAPIDS MI
49503-5098
US

IV. Provider business mailing address

401 HALL ST SW STE 185A
GRAND RAPIDS MI
49503-5098
US

V. Phone/Fax

Practice location:
  • Phone: 616-813-3394
  • Fax:
Mailing address:
  • Phone: 616-813-3394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY SUE LICHON-TUFER
Title or Position: CLINICAL SOCIAL WORKER/THERAPIST
Credential: LMSW
Phone: 616-813-3394