=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417834151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPY HAVEN SUPPORT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2025
-----------------------------------------------------
Last Update Date | 08/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5275 EDINA INDUSTRIAL BLVD STE 106
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55439-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-253-7764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5275 EDINA INDUSTRIAL BLVD STE 106
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55439-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-253-7764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICSW, OWNER
-----------------------------------------------------
Name | HOLLI ENGELHART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-253-7764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------