Pediatric Haven

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

PEDIATRIC HAVEN

Practice address

102 Lexington Dr
Madison, MS 39110-6952

Phone

(601) 499-6696

Fax

(601) 499-6696

NPI assigned

Dec 20, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Jetuwan M. Brown, RNNPI 1104176049

Title

Managing Partner

Phone

(601) 622-2997

Specialties & licenses 9

Addresses

Other names 1

• Pediatric Haven Autism Center Doing business as

Practitioners 1

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

• Jetuwan M Brown, REGISTERED NURSE

  • Registered Nurse
  • Canton, MS
  • NPI 1104176049
  NPD Authorized official

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1043858053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 HONOURS DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106513",
            "telephone_number": "601-622-2997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 LEXINGTON DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106952",
            "telephone_number": "601-499-6696",
            "fax_number": "601-499-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "JETUWAN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "601-622-2997",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2065X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Physical Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Haven Autism Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Addison Passman
• Payalben Baldev Patel, DMD, MS
• Sejalben P Patel, PHARM.D
• Peace of Mind Health and Wellness
• Hannah Michelle Pearson, PLPC
• Cassandria Hicks Peoples, LCSW
• Pamela Peoples
• Elizabeth Henderson Perry, M.D.
• Pharmacy Group of Mississippi, LLC
• Catherine P. Phillippi, M.D.

• All providers in Madison, MS
• Adolescent and Children Mental Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; 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.