Healthcare Provider Details

I. General information

NPI: 1366123945
Provider Name (Legal Business Name): TYQUAN MILLS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 S WESTNEDGE AVE STE 1203
KALAMAZOO MI
49008-3284
US

IV. Provider business mailing address

4341 S WESTNEDGE AVE STE 1203
KALAMAZOO MI
49008-3284
US

V. Phone/Fax

Practice location:
  • Phone: 269-823-2375
  • Fax:
Mailing address:
  • Phone: 269-823-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801123008
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: