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General NPI Number Information
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NPI Number | 1790596872
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Entity Type | Organization
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Legal Business Name | HAVEN PSYCHOTHERAPY LICENSED CLINICAL SOCIAL WORKER CORP
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 13422 NEWPORT AVE STE L
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City | TUSTIN
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State | CA
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Zip | 92780-3746
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Country | US
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Telephone | 949-484-8124
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Fax |
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Provider Business Mailing Address
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Address Line | 13422 NEWPORT AVE STE L
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City | TUSTIN
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State | CA
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Zip | 92780-3746
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Country | US
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Telephone | 949-484-8124
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Fax |
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Authorized Official
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Title or Position | CEO AND FOUNDER
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Name | ANDREA OWEN
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Credential | MSW, M.ED., LCSW
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Telephone | 949-484-8124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 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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