Provider Demographics
NPI:1699018606
Name:TRIEU, ASHLEY MCKENZIE (MA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MCKENZIE
Last Name:TRIEU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6879 CYPRESS BAY DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7775
Mailing Address - Country:US
Mailing Address - Phone:810-820-5832
Mailing Address - Fax:
Practice Address - Street 1:8175 CREEKSIDE DR STE 110
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5370
Practice Address - Country:US
Practice Address - Phone:269-248-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018071101YP2500X
MI2401642103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty