Provider Demographics
NPI:1760846323
Name:GUEST, TYNESHA (LMSW)
Entity Type:Individual
Prefix:
First Name:TYNESHA
Middle Name:
Last Name:GUEST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 W SAGINAW HWY
Mailing Address - Street 2:#145
Mailing Address - City:5859 W SAGINAW HWY
Mailing Address - State:MI
Mailing Address - Zip Code:48917-2460
Mailing Address - Country:US
Mailing Address - Phone:517-384-2929
Mailing Address - Fax:
Practice Address - Street 1:3300 LANSING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1621
Practice Address - Country:US
Practice Address - Phone:517-784-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096906104100000X
MI68011040231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker