MEDICARE: KIM NGOC T NGUYEN LBSW, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401019075	MI
2	104100000X	Social Worker	6802087828	MI
3	101Y00000X	Counselor	6401019075	MI

General Provider Information

NPI Number	:	1083048441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM NGOC T NGUYEN LBSW, LPC

Provider Business Mailing Address
First Line	:	3104 KETTERING HTS
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48507-4560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 KETTERING HTS
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48507-4560
Country	:	US
Telephone Number	:	316-300-0407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	03/27/2025

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