NPIMap

Organization Active NPI

Self Haven LLC

  • Mental Health Counselor
  • Cantonment, FL
National Provider Identifier
1013499441
Registry record updated Sep 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH11872 Issued in FL
Legal business name
SELF HAVEN LLC
Practice address
1105 Carla Drive
Cantonment, FL 32533
Phone
(850) 449-3883
Fax
(850) 607-9039
NPI assigned
Sep 1, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa D Garner, LMHCNPI 1457609232
Title
Owner
Phone
(850) 449-3883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X MH11872 FL Primary

Addresses

Primary practice location

1105 Carla Drive
Cantonment, FL 32533

Mailing address

1105 Carla Drive
Cantonment, FL 32533
Phone (850) 449-3883

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535760000000",
    "number": "1013499441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 CARLA DRIVE",
            "city": "CANTONMENT",
            "state": "FL",
            "postal_code": "32533",
            "telephone_number": "850-449-3883",
            "fax_number": "850-607-9039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 CARLA DRIVE",
            "city": "CANTONMENT",
            "state": "FL",
            "postal_code": "32533",
            "telephone_number": "850-449-3883",
            "fax_number": "850-607-9039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-01",
        "last_updated": "2018-09-01",
        "status": "A",
        "authorized_official_last_name": "GARNER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-449-3883",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cantonment, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.