MEDICARE: FAIRHAVEN FOUNDATION, INC.

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	:	1689722456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRHAVEN FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	117 GUISE PARK DR
Second Line	:
City	:	MUNROE FALLS
State	:	OH
Zip	:	44262-1514
Country	:	US
Telephone Number	:	330-472-3078
Fax Number	:	234-263-6005

Provider Business Practice Location Address
First Line	:	117 GUISE PARK DR
Second Line	:
City	:	MUNROE FALLS
State	:	OH
Zip	:	44262-1514
Country	:	US
Telephone Number	:	330-472-3078
Fax Number	:	234-263-6005

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. COLLIN A MYERS
Credential	:	PH.D., PCC
Telephone Number	:	330-472-3078

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/11/2025

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