Provider Demographics
NPI:1265974976
Name:LICHON-TUFER, KIMBERLY SUE (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:LICHON-TUFER
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 1:680 3 MILE RD NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8218
Mailing Address - Country:US
Mailing Address - Phone:616-647-3460
Mailing Address - Fax:616-647-3467
Practice Address - Street 1:680 3 MILE RD NW
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8218
Practice Address - Country:US
Practice Address - Phone:616-647-3460
Practice Address - Fax:616-647-3467
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010858291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical