MEDICARE: HAVEN BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator
3	251S00000X	Community/Behavioral Health Agency
4	385H00000X	Respite Care
5	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1093673279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	959 SAINT CLAIR AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3059
Country	:	US
Telephone Number	:	419-973-0368
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 SAINT CLAIR AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3059
Country	:	US
Telephone Number	:	419-973-0368
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SUPERVISOR
Name	:	ELIZABETH GRAY
Credential	:	LISW-S
Telephone Number	:	419-973-0368

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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