Healthcare Provider Details

I. General information

NPI: 1124902341
Provider Name (Legal Business Name): CALM HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 CENTERVILLE RD APT 307
WHITE BEAR LAKE MN
55127-2312
US

IV. Provider business mailing address

7362 UNIVERSITY AVE NE # 31051065
FRIDLEY MN
55432-3142
US

V. Phone/Fax

Practice location:
  • Phone: 218-256-2536
  • Fax:
Mailing address:
  • Phone: 218-256-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
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: CRYSTAL VILEN
Title or Position: OWNER/THERAPIST
Credential: LICSW
Phone: 218-256-2536