Provider Demographics
NPI:1700086634
Name:CHUNG, HENRY CHIYUNG (LLP,LMSW)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:CHIYUNG
Last Name:CHUNG
Suffix:
Gender:M
Credentials:LLP,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 DAWN DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-4026
Mailing Address - Country:US
Mailing Address - Phone:989-839-0045
Mailing Address - Fax:
Practice Address - Street 1:3115 DAWN DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-4026
Practice Address - Country:US
Practice Address - Phone:989-839-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010644061041C0700X
MI6301007482103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical