MEDICARE: THE HAVEN THERAPY, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1184486789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HAVEN THERAPY, LLC

Provider Business Mailing Address
First Line	:	3939 N WASHINGTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1817
Country	:	US
Telephone Number	:	765-667-0476
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 N WASHINGTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1817
Country	:	US
Telephone Number	:	765-667-0476
Fax Number	:

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	KELSIE STRAND
Credential	:	LCSW
Telephone Number	:	765-667-0476

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	01/30/2024

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Directions to “THE HAVEN THERAPY, LLC ” Practice Location

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