Provider Demographics
NPI:1619780442
Name:VAN GREUNEN, HUMARI
Entity type:Individual
Prefix:
First Name:HUMARI
Middle Name:
Last Name:VAN GREUNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 TECH ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3446
Mailing Address - Country:US
Mailing Address - Phone:870-573-7398
Mailing Address - Fax:
Practice Address - Street 1:210 TECH ST
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3446
Practice Address - Country:US
Practice Address - Phone:870-573-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health