Provider Demographics
NPI:1427838747
Name:SERENE HAVEN BEHAVIORAL CLINIC LLC
Entity type:Organization
Organization Name:SERENE HAVEN BEHAVIORAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OREDUNNI
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNTODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-553-8157
Mailing Address - Street 1:4301 WATERFORD GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4301 WATERFORD GLEN DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9104
Practice Address - Country:US
Practice Address - Phone:469-694-8001
Practice Address - Fax:469-613-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty