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General NPI Number Information
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NPI Number | 1235689951
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Entity Type | Organization
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Legal Business Name | HAVEN BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 1409 E CAPITOL DR SUITE 202
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City | MILWAUKEE
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State | WI
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Zip | 53211-1900
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Country | US
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Telephone | 414-963-8711
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Fax | 866-545-1113
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Provider Business Mailing Address
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Address Line | 10105 W COLDSPRING RD APT. # A -106
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City | GREENFIELD
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State | WI
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Zip | 53228-2659
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Country | US
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Telephone | 414-559-0845
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. PATRICIA MICHELLE CARRINGTON
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Credential | LPC
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Telephone | 414-559-0845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3202-226
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License Number State | WI
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