# VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1982916045
- **Legal business name:** VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
- **Authorized official:** MRS. DEBRA L-R HESS (C.E.O.)
- **Authorized official phone:** (269) 657-5574

## Contact information

- **Practice address:** 57418 CR 681, SUITE C, HARTFORD, MI 49057
- **Practice address phone:** (269) 621-6251
- **Practice address fax:** (269) 621-6044
- **Mailing address:** P.O. BOX 249, 801 HAZEN STREET SUITE C, PAW PAW, MI 49079-0249
- **Mailing address phone:** (269) 657-5574
- **Mailing address fax:** (269) 657-3474

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/06/2010
- **Last updated:** 07/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1705298 | — | MI |