MEDICARE: MRS. MARY ANN VAN BUSKIRK M.A., M,DIV., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CO LPC 527	CO
2	106H00000X	Marriage & Family Therapist	SD LMFT 1076	CO

General Provider Information

NPI Number	:	1871609438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANN VAN BUSKIRK M.A., M,DIV., LPC

Provider Business Mailing Address
First Line	:	4155 E JEWELL AVE
Second Line	:	SUITE #1100
City	:	DENVER
State	:	CO
Zip	:	80222-4504
Country	:	US
Telephone Number	:	303-692-8006
Fax Number	:	303-692-8338

Provider Business Practice Location Address
First Line	:	4155 E JEWELL AVE
Second Line	:	SUITE #1100
City	:	DENVER
State	:	CO
Zip	:	80222-4504
Country	:	US
Telephone Number	:	303-692-8006
Fax Number	:	303-692-8338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	09/11/2025

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