Provider Demographics
NPI:1235689951
Name:HAVEN BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HAVEN BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:414-559-0845
Mailing Address - Street 1:10105 W COLDSPRING RD
Mailing Address - Street 2:APT. # A -106
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2659
Mailing Address - Country:US
Mailing Address - Phone:414-559-0845
Mailing Address - Fax:
Practice Address - Street 1:1409 E CAPITOL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-1900
Practice Address - Country:US
Practice Address - Phone:414-963-8711
Practice Address - Fax:866-545-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3202-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty