Basic Information
| Provider Information | |||||||||
| NPI: | 1952558314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAVENS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5537 BLEAUX AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727620737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4798725580 | ||||||||
| FaxNumber: | 4798725581 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 MOCKINGBIRD LN | ||||||||
| Address2: | STE B & C | ||||||||
| City: | PARAGOULD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724505806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702400671 | ||||||||
| FaxNumber: | 8702400514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2008 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.