MEDICARE: HAVEN MIND BODY COLLECTIVE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184477507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN MIND BODY COLLECTIVE, LLC

Provider Business Mailing Address
First Line	:	1105 15TH AVE STE F
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3080
Country	:	US
Telephone Number	:	360-703-6499
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 15TH AVE STE F
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3080
Country	:	US
Telephone Number	:	360-703-6499
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED COUNSELOR
Name	:	AMANDA RENEE HART
Credential	:	CC
Telephone Number	:	360-562-5509

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

Similar Medicare Providers

1588714737 — MS. VIVIAN M PERALTA MESA MS, LMFT
Practice Location Address:

1105 15TH AVE STE F
LONGVIEW, WA
98632-3080

Practice Phone: 704-910-7942
Practice Fax:

1164699013 — AMANDA RENEE HART CC, LMT
Practice Location Address:

1105 15TH AVE STE F
LONGVIEW, WA
98632-3080

Practice Phone: 360-703-6499
Practice Fax: 360-838-9902

1861956492 — MRS. ALEXIS CORINNE NORMANDEAU ME
Practice Location Address:

1105D 15TH AVE , #123
LONGVIEW, WA
98632-3080

Practice Phone: 185-583-2672
Practice Fax:

1982282323 — CARRIE-ANN LAVERY
Practice Location Address:

1105D 15TH AVE # 123
LONGVIEW, WA
98632-3080

Practice Phone: 855-832-6727
Practice Fax: 772-675-9100

1427997279 — SARAH PRYOR LMT
Practice Location Address:

1105 15TH AVE STE F
LONGVIEW, WA
98632-3080

Practice Phone: 360-762-4806
Practice Fax:

1972550630 — DR. MARC J MEADOWS DDS
Practice Location Address:

3080 N EASTMAN RD
LONGVIEW, TX
75605-5174

Practice Phone: 903-309-2152
Practice Fax:

Directions to “HAVEN MIND BODY COLLECTIVE, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.