=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689595126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAFEN BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2026
-----------------------------------------------------
Last Update Date | 07/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 332 APPLE LEAF AVE
-----------------------------------------------------
City | KAYSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84037-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-485-5354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 N MAIN ST STE D PMB # 331
-----------------------------------------------------
City | KAYSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84037-1424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-485-5354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | BLAKE KENNETH HAFEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 385-485-5354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------