NPIMap

Organization Active NPI

Van Buren Community Mental Health Authority

  • Psychiatry Physician
  • Hartford, MI
National Provider Identifier
1295097889
Registry record updated Aug 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Practice address
57418 County Road 681
Suite C
Hartford, MI 49057
Phone
(269) 621-6251
Fax
(269) 621-6044
NPI assigned
Jun 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Debra L-R Hess, CEO
Title
Chief Executive Officer
Phone
(269) 657-5574

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

57418 County Road 681
Suite C
Hartford, MI 49057

Mailing address

P.O. Box 249, 801 Hazen Street
Suite C
Paw Paw, MI 49079-0249
Phone (269) 657-5574

Other identifiers 1

IdentifierTypeStateIssuer
1705298MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Van Bure Community Mental Health6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534118400000",
    "number": "1295097889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 249, 801 HAZEN STREET",
            "address_2": "SUITE C",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790249",
            "telephone_number": "269-657-5574",
            "fax_number": "269-657-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57418 COUNTY ROAD 681",
            "address_2": "SUITE C",
            "city": "HARTFORD",
            "state": "MI",
            "postal_code": "49057",
            "telephone_number": "269-621-6251",
            "fax_number": "269-621-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-11",
        "last_updated": "2018-08-13",
        "status": "A",
        "authorized_official_last_name": "HESS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "L-R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "269-657-5574",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1705298",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.