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General NPI Number Information
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NPI Number | 1386352862
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Entity Type | Organization
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Legal Business Name | HAVENS OF MINNESOTA LLC
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1003 CLOQUET AVE STE 117
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City | CLOQUET
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State | MN
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Zip | 55720-1649
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Country | US
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Telephone | 218-879-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 WOODDALE DR STE B
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City | WOODBURY
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State | MN
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Zip | 55125-4442
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Country | US
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Telephone | 651-734-9633
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Fax | 651-734-9533
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Authorized Official
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Title or Position | CEO
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Name | TEDD HERMAN
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Credential |
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Telephone | 612-895-4605
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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