Healthcare Provider Details

I. General information

NPI: 1962322388
Provider Name (Legal Business Name): HAVEN PATH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 CRYSTAL SPRINGS LN N
KEIZER OR
97303-3863
US

IV. Provider business mailing address

312 CRYSTAL SPRINGS LN N
KEIZER OR
97303-3863
US

V. Phone/Fax

Practice location:
  • Phone: 541-905-0109
  • Fax:
Mailing address:
  • Phone: 541-905-0109
  • 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: TARANUM CHAUDRY
Title or Position: MENTAL HEALTH PROVIDER
Credential: LMFT, PH.D.
Phone: 541-905-0109