Provider Demographics
NPI:1245606888
Name:SAFE HAVEN COUNSELING LLC
Entity Type:Organization
Organization Name:SAFE HAVEN COUNSELING LLC
Other - Org Name:FORREST HILL OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-346-7731
Mailing Address - Street 1:1490 S MILITARY TRL
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9190
Mailing Address - Country:US
Mailing Address - Phone:561-346-7731
Mailing Address - Fax:
Practice Address - Street 1:1490 S MILITARY TRL
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9190
Practice Address - Country:US
Practice Address - Phone:561-346-7731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2100079261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder