Provider Demographics
NPI:1790893246
Name:S.A.F.E. HAVEN, INC.
Entity Type:Organization
Organization Name:S.A.F.E. HAVEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:CHERYLIN
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:479-478-6040
Mailing Address - Street 1:2300 S 57TH ST
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3808
Mailing Address - Country:US
Mailing Address - Phone:479-478-6040
Mailing Address - Fax:479-478-6140
Practice Address - Street 1:2300 S 57TH ST
Practice Address - Street 2:SUITE 9A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3808
Practice Address - Country:US
Practice Address - Phone:479-478-6040
Practice Address - Fax:479-478-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR97-16P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5T820Medicare ID - Type Unspecified