Pediatric Haven

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

PEDIATRIC HAVEN

Doing business as

Pediatric Haven Autism Center

Practice address

110 S Pearson Rd Ste 2
Pearl, MS 39208-5635

Phone

(601) 278-6710

Fax

(601) 499-0294

NPI assigned

Dec 20, 2019

Last updated

Nov 4, 2026By the provider in NPPES

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) 278-6710

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, and the practitioner matching its NPPES authorized official.

• 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": "1793750400000",
    "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": "601-278-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S PEARSON RD STE 2",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392085635",
            "telephone_number": "601-278-6710",
            "fax_number": "601-499-0294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2026-11-04",
        "certification_date": "2026-11-04",
        "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": "601-278-6710",
        "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"
        }
    ]
}

• Dennetta Delorise Parker, FNP
• Ventasha S Parker
• Pearl Family Clinic
• Pearl River Dental, PLLC
• Pearls Children's Clinic PLLC (EmPower Childrens Clinic)
• Monique Pendleton
• Amanda Perry
• Hoa Pham, PHARM.D
• Barry Wade Phillips
• Missy Giachelli Phillips

• Adolescent and Children Mental Health Clinic/Center in Pearl, MS
• Providers in Pearl, MS by specialty
• 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 Nov 4, 2026; 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.