Provider Demographics
NPI:1164829321
Name:SAFE HAVEN REFUGE
Entity Type:Organization
Organization Name:SAFE HAVEN REFUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:844-212-1382
Mailing Address - Street 1:7924 BROADWAY ST
Mailing Address - Street 2:STE 108
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7932
Mailing Address - Country:US
Mailing Address - Phone:281-678-4622
Mailing Address - Fax:
Practice Address - Street 1:7924 BROADWAY ST
Practice Address - Street 2:STE 108
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7932
Practice Address - Country:US
Practice Address - Phone:281-678-4622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65480101YP2500X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty