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General NPI Number Information
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NPI Number | 1699018606
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Entity Type | Individual
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Provider Name | ASHLEY MCKENZIE TRIEU M.A.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 10/01/2023
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Provider Practice Location Address
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Address Line | 8175 CREEKSIDE DR STE 110
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City | PORTAGE
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State | MI
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Zip | 49024-5370
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Country | US
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Telephone | 269-248-1006
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Fax |
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Provider Business Mailing Address
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Address Line | 6879 CYPRESS BAY DR
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City | KALAMAZOO
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State | MI
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Zip | 49009-7775
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Country | US
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Telephone | 810-820-5832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401018071
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2401642
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License Number State | MI
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