Provider Demographics
NPI:1487301669
Name:TUNNEY, JON LEE (LLC)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:LEE
Last Name:TUNNEY
Suffix:
Gender:M
Credentials:LLC
Other - Prefix:
Other - First Name:ELLE
Other - Middle Name:
Other - Last Name:TUNNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLC
Mailing Address - Street 1:1115 PETOSKEY ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-519-0070
Mailing Address - Fax:
Practice Address - Street 1:1000 MONROE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1455
Practice Address - Country:US
Practice Address - Phone:616-259-7207
Practice Address - Fax:616-259-7261
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022130101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty