Provider Demographics
NPI:1881308666
Name:KIMBERLY LICHON-TUFER
Entity type:Organization
Organization Name:KIMBERLY LICHON-TUFER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LICHON-TUFER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-813-3394
Mailing Address - Street 1:401 HALL ST SW STE 185A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5098
Mailing Address - Country:US
Mailing Address - Phone:616-813-3394
Mailing Address - Fax:
Practice Address - Street 1:401 HALL ST SW STE 185A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5098
Practice Address - Country:US
Practice Address - Phone:616-813-3394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMBERLY LICHON-TUFER, LMSW, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVS0114295Medicaid