Provider Demographics
NPI:1407905052
Name:HAVENS, BARBARA JEAN (LCPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:HAVENS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 REMINGTON GREEN DR SE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6873
Mailing Address - Country:US
Mailing Address - Phone:815-494-9678
Mailing Address - Fax:
Practice Address - Street 1:550 REMINGTON GREEN DR SE UNIT 103
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6873
Practice Address - Country:US
Practice Address - Phone:815-494-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMH1535101YM0800X
IL180005831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health