=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033022504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAVEN PSYCHIATRY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2026
-----------------------------------------------------
Last Update Date | 09/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 N GRANT ST STE N
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-526-9334
-----------------------------------------------------
Fax | 704-704-1053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 N GRANT ST STE N
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-999-0466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC NURSE PRACTITIONER
-----------------------------------------------------
Name | MAGGIE WHITT MAZUREK
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 704-526-9334
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------