Provider Demographics
NPI:1942056122
Name:HAVEN MENTAL HEALTH & WELLNESS
Entity type:Organization
Organization Name:HAVEN MENTAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:SALYER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:307-871-2728
Mailing Address - Street 1:1792 S LAKE DR STE 90-235
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6824
Mailing Address - Country:US
Mailing Address - Phone:803-694-7040
Mailing Address - Fax:803-694-7038
Practice Address - Street 1:3237 EMANUEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8940
Practice Address - Country:US
Practice Address - Phone:803-694-7040
Practice Address - Fax:803-694-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-27
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty