=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265345276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAVEN HOUSE COUNSELING AND CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2026
-----------------------------------------------------
Last Update Date | 09/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 196 PARKWAY CIR STE 6
-----------------------------------------------------
City | WEST MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71292-8057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-505-0118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 WIDGEON WAY
-----------------------------------------------------
City | WEST MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71291-9121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-500-5118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR AND OWNER
-----------------------------------------------------
Name | MRS. FREDDIE HODGES AMOS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 214-505-0118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------