Provider Demographics
NPI:1396857710
Name:VAN BUREN, HOLLY (MSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:VAN BUREN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-1570
Mailing Address - Country:US
Mailing Address - Phone:989-799-6542
Mailing Address - Fax:
Practice Address - Street 1:304 S NIAGARA ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-1570
Practice Address - Country:US
Practice Address - Phone:989-799-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010901121041C0700X
MIC-00420101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0910448OtherBCBS PIN
MI0910448OtherBCBS PIN