Provider Demographics
NPI:1417692815
Name:THE HAVEN MENTAL HEALTH AND WELLNESS PLLC
Entity Type:Organization
Organization Name:THE HAVEN MENTAL HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOTTEN-GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-497-8138
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-0729
Mailing Address - Country:US
Mailing Address - Phone:918-497-8138
Mailing Address - Fax:
Practice Address - Street 1:303 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-3421
Practice Address - Country:US
Practice Address - Phone:918-956-9014
Practice Address - Fax:918-514-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care