Provider Demographics
NPI:1760530166
Name:TRAN, MY UYEN (LMSW, MSW)
Entity Type:Individual
Prefix:
First Name:MY UYEN
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:LMSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0585
Mailing Address - Country:US
Mailing Address - Phone:616-617-0296
Mailing Address - Fax:
Practice Address - Street 1:2015 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-4003
Practice Address - Country:US
Practice Address - Phone:616-617-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010672241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical