Provider Demographics
NPI:1689722456
Name:FAIRHAVEN FOUNDATION, INC.
Entity Type:Organization
Organization Name:FAIRHAVEN FOUNDATION, INC.
Other - Org Name:FAIRHAVEN COUNSELING, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PCC
Authorized Official - Phone:330-940-2522
Mailing Address - Street 1:2675 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2648
Mailing Address - Country:US
Mailing Address - Phone:330-940-2522
Mailing Address - Fax:330-940-3366
Practice Address - Street 1:2675 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-2648
Practice Address - Country:US
Practice Address - Phone:330-940-2522
Practice Address - Fax:330-940-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty