Provider Demographics
NPI:1497239222
Name:HAVEN COUNSELING LLC
Entity Type:Organization
Organization Name:HAVEN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KORAL
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC, CBIS
Authorized Official - Phone:605-641-2112
Mailing Address - Street 1:2711 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4211
Mailing Address - Country:US
Mailing Address - Phone:605-641-2112
Mailing Address - Fax:
Practice Address - Street 1:2650 JACKSON BLVD # 6
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3474
Practice Address - Country:US
Practice Address - Phone:605-863-2498
Practice Address - Fax:605-646-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health