Provider Demographics
NPI:1306395108
Name:H.A.V.E.N. COUNSELING & WELLNESS SERVICES
Entity Type:Organization
Organization Name:H.A.V.E.N. COUNSELING & WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD , LPC
Authorized Official - Phone:832-604-4390
Mailing Address - Street 1:4739 LONESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449
Mailing Address - Country:US
Mailing Address - Phone:832-604-4390
Mailing Address - Fax:
Practice Address - Street 1:4739 LONESTONE CIR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449
Practice Address - Country:US
Practice Address - Phone:832-604-4390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X
TX70501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty