Provider Demographics
NPI:1407447600
Name:EARTH HAVEN THERAPY INC.
Entity Type:Organization
Organization Name:EARTH HAVEN THERAPY INC.
Other - Org Name:LINDA BERT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:BERT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, CAAP
Authorized Official - Phone:818-272-6442
Mailing Address - Street 1:8760 SW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6732
Mailing Address - Country:US
Mailing Address - Phone:818-272-6442
Mailing Address - Fax:714-333-4407
Practice Address - Street 1:8760 SW 21ST CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6732
Practice Address - Country:US
Practice Address - Phone:818-272-6442
Practice Address - Fax:714-333-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108285000Medicaid