Provider Demographics
NPI:1164671962
Name:HAVEN COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:HAVEN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:SAVARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-850-8706
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:KENO
Mailing Address - State:OR
Mailing Address - Zip Code:97627-0344
Mailing Address - Country:US
Mailing Address - Phone:541-850-8706
Mailing Address - Fax:541-850-8709
Practice Address - Street 1:15555 STATE ROUTE 66
Practice Address - Street 2:SUITE 1
Practice Address - City:KENO
Practice Address - State:OR
Practice Address - Zip Code:97627
Practice Address - Country:US
Practice Address - Phone:541-850-8706
Practice Address - Fax:541-850-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL4224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherL4224