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General NPI Number Information
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NPI Number | 1144760638
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Entity Type | Organization
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Legal Business Name | BLUE HAVEN COUNSELING, INC.
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 3028 KELSEY DR
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City | EDMOND
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State | OK
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Zip | 73013-5322
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Country | US
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Telephone | 405-205-6572
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Fax |
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Provider Business Mailing Address
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Address Line | 3028 KELSEY DR
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City | EDMOND
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State | OK
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Zip | 73013-5322
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Country | US
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Telephone | 405-205-6572
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. REBECCA CAY JONES
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Credential | M.ED., LPC
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Telephone | 405-205-6572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6090
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6090
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6090
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License Number State | OK
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