Provider Demographics
NPI:1467687913
Name:BLURY, TARA (MSW, LMSW, TF-CBT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BLURY
Suffix:
Gender:F
Credentials:MSW, LMSW, TF-CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-0854
Mailing Address - Country:US
Mailing Address - Phone:616-208-4740
Mailing Address - Fax:
Practice Address - Street 1:2460 BURTON ST SE STE 301
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4801
Practice Address - Country:US
Practice Address - Phone:616-208-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010911451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical