Healthcare Provider Details

I. General information

NPI: 1255258224
Provider Name (Legal Business Name): NICOLE TIONGSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 E CORK ST
KALAMAZOO MI
49001-5026
US

IV. Provider business mailing address

2636 BRONSON BLVD
KALAMAZOO MI
49008-2447
US

V. Phone/Fax

Practice location:
  • Phone: 269-350-3213
  • Fax:
Mailing address:
  • Phone: 269-599-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: