Provider Demographics
NPI:1205699626
Name:PSYCH HAVEN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:PSYCH HAVEN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAFERANMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AFOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:128-159-4895
Mailing Address - Street 1:17401 W LAKE HOUSTON PKWY APT 7204
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5147
Mailing Address - Country:US
Mailing Address - Phone:281-594-8953
Mailing Address - Fax:
Practice Address - Street 1:3663 N SAM HOUSTON PKWY E STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3611
Practice Address - Country:US
Practice Address - Phone:281-594-8953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service