MEDICARE: SHIELD AND 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1881573038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIELD AND HAVEN THERAPY LLC

Provider Business Mailing Address
First Line	:	320 E LEWIS ST
Second Line	:
City	:	CARTERVILLE
State	:	MO
Zip	:	64835-1548
Country	:	US
Telephone Number	:	417-214-2795
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 ILLINOIS AVE STE 6
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64801-5065
Country	:	US
Telephone Number	:	417-214-2795
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HANNAH NEELY-BEAVER
Credential	:	LCSW
Telephone Number	:	417-214-2795

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	12/01/2025

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