Healthcare Provider Details

I. General information

NPI: 1821690363
Provider Name (Legal Business Name): HAVEN HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 NE 134TH ST STE 180C
VANCOUVER WA
98685-2799
US

IV. Provider business mailing address

2301 NE 81ST ST APT E43
VANCOUVER WA
98665-2023
US

V. Phone/Fax

Practice location:
  • Phone: 360-450-5778
  • Fax: 833-992-2065
Mailing address:
  • Phone: 360-980-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LANA FERRIS
Title or Position: PHYSICIAN
Credential: ND
Phone: 360-450-5778