Provider Demographics
NPI:1386532554
Name:RED HAVEN THERAPY, LLC
Entity type:Organization
Organization Name:RED HAVEN THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-640-6637
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:VIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74962-0037
Mailing Address - Country:US
Mailing Address - Phone:918-640-6637
Mailing Address - Fax:
Practice Address - Street 1:405 S MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4427
Practice Address - Country:US
Practice Address - Phone:918-640-6637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1275805095OtherINSURANCE PROVIDERS