Provider Demographics
NPI:1669333068
Name:HOUSE OF HAVEN MENTAL HEALTH LLC
Entity type:Organization
Organization Name:HOUSE OF HAVEN MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NIESHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:913-549-6955
Mailing Address - Street 1:13830 SANTA FE TRAIL DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3381
Mailing Address - Country:US
Mailing Address - Phone:913-549-6955
Mailing Address - Fax:
Practice Address - Street 1:13830 SANTA FE TRAIL DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3310
Practice Address - Country:US
Practice Address - Phone:913-549-6955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10053913Medicaid