MEDICARE: HAVEN THERAPY & COACHING PLLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1790503597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN THERAPY & COACHING PLLC

Provider Business Mailing Address
First Line	:	7932 BAYONET CIR APT D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-4693
Country	:	US
Telephone Number	:	951-231-7299
Fax Number	:

Provider Business Practice Location Address
First Line	:	7932 BAYONET CIR APT D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-4693
Country	:	US
Telephone Number	:	951-231-7299
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. VALERIE SUSANN MEDINA
Credential	:	LMFT
Telephone Number	:	951-231-7299

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	09/30/2024

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