Provider Demographics
| NPI: | 1396807350 |
|---|---|
| Name: | KINGHAVEN COUNSELING GROUP INC |
| Entity type: | Organization |
| Organization Name: | KINGHAVEN COUNSELING GROUP INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | SHEGUN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | OLAGUNDOYE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 713-457-4372 |
| Mailing Address - Street 1: | 6315 GULFTON ST |
| Mailing Address - Street 2: | SUITE 100 |
| Mailing Address - City: | HOUSTON |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77081-1107 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 713-457-4372 |
| Mailing Address - Fax: | 713-457-0945 |
| Practice Address - Street 1: | 6100 HILLCROFT AVE STE 642 |
| Practice Address - Street 2: | |
| Practice Address - City: | HOUSTON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77081-1009 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 713-457-4372 |
| Practice Address - Fax: | 713-457-0945 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-12-15 |
| Last Update Date: | 2025-06-10 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103G00000X, 103T00000X, 103TA0400X, 101YP2500X, 103TA0700X, 103TC2200X, 103TP2701X, 1041C0700X, 106H00000X, 106S00000X, 2084P0800X, 261QM1300X, 101YM0800X, 251B00000X | ||
| TX | 261QR0405X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251B00000X | Agencies | Case Management | ||
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 158284301 | Medicaid | |
| TX | 3496-3497 | Other | SUBSTANCE ABUSE FACILITY |
| TXB104840 | Medicare UPIN |
