Provider Demographics
NPI:1265959050
Name:BUREAN, HOLLY NICOLE
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICOLE
Last Name:BUREAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 LINCOLNVIEW ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3242
Mailing Address - Country:US
Mailing Address - Phone:248-270-6587
Mailing Address - Fax:
Practice Address - Street 1:15700 W 10 MILE RD STE 213
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2143
Practice Address - Country:US
Practice Address - Phone:989-225-4111
Practice Address - Fax:248-575-4555
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68010861481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical