Hickory Hollow Specialized Residential

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

HICKORY HOLLOW SPECIALIZED RESIDENTIAL

Practice address

6500 Hickory Hollow CT
Flint, MI 48532-2055

Phone

(833) 478-9464

NPI assigned

Oct 23, 2025

Organization subpart

No

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

Authorized official

Name

Gaven Bertram

Title

Licensee/Designee

Phone

(833) 478-9464

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1761177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761177600000",
    "number": "1801763750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 S DYE RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071078",
            "telephone_number": "833-478-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 HICKORY HOLLOW CT",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485322055",
            "telephone_number": "833-478-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKORY HOLLOW SPECIALIZED RESIDENTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-23",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A",
        "authorized_official_last_name": "BERTRAM",
        "authorized_official_first_name": "GAVEN",
        "authorized_official_title_or_position": "LICENSEE/DESIGNEE",
        "authorized_official_telephone_number": "833-478-9464"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Willman Hettle, MD
• Christy Lee Heusted
• Nickie Hewitt
• Melissa Marie Hickman
• Hickory Hollow II Specialized Residential Services
• Camillia Annett Hicks
• Crystal Hicks, BS
• Heather Hicks
• Jeanne Koistinen Hicks, MD
• Jill Lynn Hicks, RN, EMT-P

• Mental Health Clinic/Center (Including Community Mental Health Center) in Flint, MI
• Providers in Flint, MI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2025; 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.