Provider Demographics
NPI:1336975630
Name:HAVENSTEIN, MEAGAN KRISTI
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:KRISTI
Last Name:HAVENSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 BRITANNIA BLVD UNIT D
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1495
Mailing Address - Country:US
Mailing Address - Phone:720-590-1060
Mailing Address - Fax:
Practice Address - Street 1:379 FENNELL BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3185
Practice Address - Country:US
Practice Address - Phone:352-633-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health