Provider Demographics
NPI:1194215939
Name:DOVE HAVEN LLC
Entity Type:Organization
Organization Name:DOVE HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:720-810-1386
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80480-0882
Mailing Address - Country:US
Mailing Address - Phone:720-810-1386
Mailing Address - Fax:
Practice Address - Street 1:312 5 TH STREET
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:CO
Practice Address - Zip Code:80480
Practice Address - Country:US
Practice Address - Phone:720-810-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004733103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty