Healthcare Provider Details

I. General information

NPI: 1720993496
Provider Name (Legal Business Name): MISTY HAVEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 BRAINERD RD STE 103
CHATTANOOGA TN
37421-3524
US

IV. Provider business mailing address

5916 BRAINERD RD STE 103
CHATTANOOGA TN
37421-3524
US

V. Phone/Fax

Practice location:
  • Phone: 877-368-1865
  • Fax: 877-368-1865
Mailing address:
  • Phone: 877-368-1865
  • Fax: 877-368-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HANNAH MORGAN MARTIN
Title or Position: OWNER
Credential: LCSW
Phone: 530-368-1865