Provider Demographics
NPI:1164290136
Name:HARMONY HAVEN THERAPY, PLLC
Entity Type:Organization
Organization Name:HARMONY HAVEN THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAUDENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMO-BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-620-9876
Mailing Address - Street 1:610 SOUTH 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-620-9876
Mailing Address - Fax:
Practice Address - Street 1:610 SOUTH 18TH STREET
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-620-9876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty