Provider Demographics
NPI:1871609438
Name:VAN BUSKIRK, MARY ANN (MA, M,DIV, LPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:VAN BUSKIRK
Suffix:
Gender:F
Credentials:MA, M,DIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 E JEWELL AVE
Mailing Address - Street 2:SUITE #1100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4504
Mailing Address - Country:US
Mailing Address - Phone:303-692-8006
Mailing Address - Fax:303-692-8338
Practice Address - Street 1:4155 E JEWELL AVE
Practice Address - Street 2:SUITE #1100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4504
Practice Address - Country:US
Practice Address - Phone:303-692-8006
Practice Address - Fax:303-692-8338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO LPC 527101YP2500X
COSD LMFT 1076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist