Healthcare Provider Details

I. General information

NPI: 1881509891
Provider Name (Legal Business Name): HEALING HAVEN PSYCHOTHERAPY A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S ORANGE GROVE BLVD
PASADENA CA
91105-1705
US

IV. Provider business mailing address

735 CANYON CREST DR
SIERRA MADRE CA
91024-1311
US

V. Phone/Fax

Practice location:
  • Phone: 626-217-2571
  • Fax:
Mailing address:
  • Phone: 626-217-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA JOHNSON
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 626-318-4207