Healthcare Provider Details

I. General information

NPI: 1487435251
Provider Name (Legal Business Name): SAFE HAVEN FAMILY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 FOXTRAIL DR STE 121
LOVELAND CO
80538-9086
US

IV. Provider business mailing address

1635 FOXTRAIL DR STE 121
LOVELAND CO
80538-9086
US

V. Phone/Fax

Practice location:
  • Phone: 970-460-8015
  • Fax:
Mailing address:
  • Phone: 970-460-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MURRAY
Title or Position: OWNER
Credential: PHD
Phone: 970-460-8015