Provider Demographics
NPI:1578263554
Name:JESSES HAVEN
Entity Type:Organization
Organization Name:JESSES HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-209-8025
Mailing Address - Street 1:2081 HARRODSBURG RD # 1117
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3503
Mailing Address - Country:US
Mailing Address - Phone:502-209-8025
Mailing Address - Fax:
Practice Address - Street 1:4124 KATHERINE PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-4000
Practice Address - Country:US
Practice Address - Phone:502-209-8025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty