1164671962 NPI number — HAVEN COUNSELING SERVICES, LLC

Table of content: APRIL MELISSA SHEETS ATC (NPI 1770795742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164671962 NPI number — HAVEN COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVEN COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164671962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97627-0344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-850-8706
Provider Business Mailing Address Fax Number:
541-850-8709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15555 STATE ROUTE 66
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
KENO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-850-8706
Provider Business Practice Location Address Fax Number:
541-850-8709
Provider Enumeration Date:
09/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SAVARD
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
MITCHELL
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
541-850-8706

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  L4224 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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