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General NPI Number Information
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NPI Number | 1790893246
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Entity Type | Organization
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Legal Business Name | S.A.F.E. HAVEN, INC.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2300 S 57TH ST SUITE 9A
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City | FORT SMITH
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State | AR
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Zip | 72903-3808
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Country | US
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Telephone | 479-478-6040
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Fax | 479-478-6140
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Provider Business Mailing Address
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Address Line | 2300 S 57TH ST SUITE 9A
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City | FORT SMITH
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State | AR
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Zip | 72903-3808
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Country | US
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Telephone | 479-478-6040
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Fax | 479-478-6140
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Authorized Official
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Title or Position | CLLINICAL PSYCHOLOGIST
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Name | DR. NANCY CHERYLIN POWELL
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Credential | PSY.D.
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Telephone | 479-478-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 97-16P
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License Number State | AR
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