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NPI Code Detail

MEDICARE: MS. SUSAN MARIE HAVENS LPCC-S

MEDICARE: MS. SUSAN MARIE HAVENS LPCC-S
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
1101Y00000XCounselorC8265OH

General Provider Information

NPI Number : 1821214677
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN MARIE HAVENS LPCC-S
Provider Business Mailing Address
First Line : 4731 STATE ROUTE 207 NE
Second Line :
City : WASHINGTON COURT HOUSE
State : OH
Zip : 43160-8722
Country : US
Telephone Number : 740-463-3581
Fax Number :
Provider Business Practice Location Address
First Line : 600 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45410-1122
Country : US
Telephone Number : 740-335-3126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/21/2022

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