Provider Demographics
NPI:1366206971
Name:SAFE HAVEN COUNSELING AND CONSULTATION SERVICES LLC
Entity type:Organization
Organization Name:SAFE HAVEN COUNSELING AND CONSULTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DERLETH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:219-331-8081
Mailing Address - Street 1:129 BENJAMIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-1881
Mailing Address - Country:US
Mailing Address - Phone:219-331-8081
Mailing Address - Fax:
Practice Address - Street 1:129 BENJAMIN ST
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-1881
Practice Address - Country:US
Practice Address - Phone:219-331-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty