Healthcare Provider Details

I. General information

NPI: 1942138987
Provider Name (Legal Business Name): SAFE HAVEN MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BRENTSHIRE SQUARE
JACKSON TN
38305
US

IV. Provider business mailing address

3414 RIVERSIDE DR
JACKSON TN
38301-9130
US

V. Phone/Fax

Practice location:
  • Phone: 731-217-0885
  • Fax:
Mailing address:
  • Phone: 731-217-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HENNING
Title or Position: NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 731-217-0885