MEDICARE: HAVEN OF THE HEART COUNSELING SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1033819446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN OF THE HEART COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2908 WATERFRONT CV
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-8041
Country	:	US
Telephone Number	:	501-920-9625
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W BROADWAY ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-5628
Country	:	US
Telephone Number	:	501-487-1558
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHALAE N HESSELBEIN
Credential	:	LCSW
Telephone Number	:	501-920-9625

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	04/14/2023

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