Provider Demographics
NPI:1467238808
Name:SAFE HAVEN THERAPY LLC
Entity Type:Organization
Organization Name:SAFE HAVEN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MBC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-703-9084
Mailing Address - Street 1:420 ST JOHN
Mailing Address - Street 2:
Mailing Address - City:THAYER
Mailing Address - State:MO
Mailing Address - Zip Code:65791-8500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 ST JOHN
Practice Address - Street 2:
Practice Address - City:THAYER
Practice Address - State:MO
Practice Address - Zip Code:65791-8500
Practice Address - Country:US
Practice Address - Phone:800-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty