Healthcare Provider Details

I. General information

NPI: 1114538337
Provider Name (Legal Business Name): HEALTHY HAVEN COUNSELING & CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 N PRINCE ST STE H
CLOVIS NM
88101-3843
US

IV. Provider business mailing address

2905 N PRINCE ST STE H
CLOVIS NM
88101-3843
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-4460
  • Fax: 575-914-6407
Mailing address:
  • Phone: 888-374-4460
  • Fax: 575-914-6407

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: RENITA BORDERS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 575-791-3596