Healthcare Provider Details

I. General information

NPI: 1629969068
Provider Name (Legal Business Name): VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HAZEN ST STE C
PAW PAW MI
49079-2008
US

IV. Provider business mailing address

801 HAZEN ST STE C
PAW PAW MI
49079-2008
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-5574
  • Fax:
Mailing address:
  • Phone: 269-657-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA HESS
Title or Position: CEO
Credential:
Phone: 269-655-3366