Provider Demographics
NPI:1124760624
Name:MENTAL HAVEN, LLC
Entity type:Organization
Organization Name:MENTAL HAVEN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:313-300-0567
Mailing Address - Street 1:3066 ZELDA RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2651
Mailing Address - Country:US
Mailing Address - Phone:313-300-0567
Mailing Address - Fax:334-888-8599
Practice Address - Street 1:3630 S PERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36105-2203
Practice Address - Country:US
Practice Address - Phone:334-625-0779
Practice Address - Fax:334-888-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty