=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124902341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALM HAVEN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4770 CENTERVILLE RD APT 307
-----------------------------------------------------
City | WHITE BEAR LAKE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55127-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-256-2536
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7362 UNIVERSITY AVE NE # 31051065
-----------------------------------------------------
City | FRIDLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55432-3142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-256-2536
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | CRYSTAL VILEN
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 218-256-2536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------