Healthcare Provider Details

I. General information

NPI: 1902533805
Provider Name (Legal Business Name): BRIGID EILLEEN HAVENS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 143
CALUMET MI
49913-0143
US

IV. Provider business mailing address

PO BOX 143
CALUMET MI
49913-0143
US

V. Phone/Fax

Practice location:
  • Phone: 906-319-8725
  • Fax:
Mailing address:
  • Phone: 906-319-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401224540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: