Healthcare Provider Details

I. General information

NPI: 1609701176
Provider Name (Legal Business Name): NEUROHAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7787 FM 1173
KRUM TX
76249-4422
US

IV. Provider business mailing address

7787 FM 1173
KRUM TX
76249-4422
US

V. Phone/Fax

Practice location:
  • Phone: 940-368-9952
  • Fax:
Mailing address:
  • Phone: 940-368-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN DENNARD BARKER
Title or Position: MANAGING DIRECTOR
Credential: LCL
Phone: 940-368-9952