Provider Demographics
NPI:1114538337
Name:HEALTHY HAVEN COUNSELING & CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:HEALTHY HAVEN COUNSELING & CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-791-3596
Mailing Address - Street 1:2905 N PRINCE ST STE H
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3843
Mailing Address - Country:US
Mailing Address - Phone:888-374-4460
Mailing Address - Fax:575-914-6407
Practice Address - Street 1:2905 N PRINCE ST STE H
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3843
Practice Address - Country:US
Practice Address - Phone:888-374-4460
Practice Address - Fax:575-914-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61556564Medicaid