Healthcare Provider Details

I. General information

NPI: 1881573038
Provider Name (Legal Business Name): SHIELD AND HAVEN THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 ILLINOIS AVE STE 6
JOPLIN MO
64801-5065
US

IV. Provider business mailing address

705 ILLINOIS AVE STE 6
JOPLIN MO
64801-5065
US

V. Phone/Fax

Practice location:
  • Phone: 417-214-2795
  • Fax:
Mailing address:
  • Phone: 417-316-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HANNAH NEELY-BEAVER
Title or Position: OWNER
Credential: LCSW
Phone: 417-214-2795