NPIMap

Organization Active NPI

M3 Haven Inc.

Doing business as Ellie Mental Health - Space Coast

  • Clinical Social Worker
  • Melbourne, FL
National Provider Identifier
1831945484
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
M3 HAVEN INC.
Doing business as
Ellie Mental Health - Space Coast
Practice address
6769 N Wickham Rd # B101
Melbourne, FL 32940-2048
Phone
(321) 525-1103
Fax
(833) 767-2919
NPI assigned
Apr 25, 2024
Last updated
Mar 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Authorized official

Name
Michael Mosley
Title
Vice President
Phone
(321) 525-1103

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X Primary
Marriage & Family Therapist 106H00000X

Addresses

Primary practice location

6769 N Wickham Rd # B101
Melbourne, FL 32940-2048

Mailing address

6769 N Wickham Rd Ste B101
Melbourne, FL 32940-2048
Phone (321) 241-4286

Other practice location 1

930 S Harbor City Blvd Ste 100
Melbourne, FL 32901-1901
Phone (321) 241-4286

Other names 1

  • Ellie Mental Health - Space Coast Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240827004266 FL Part B Supplier - Clinic/Group Practice 9436698040 Receives reassigned benefits from 12 practitioners
Practice locations: Melbourne, FL

National Provider Directory

National Provider Directory

Locations

6769 N Wickham Rd
#B101
Melbourne, FL 32940
Phone (321) 525-1103

6769 N Wickham Rd
Ste B101
Melbourne, FL 32940
Phone (321) 321-1490

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1831945484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6769 N WICKHAM RD STE B101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402048",
            "telephone_number": "321-241-4286",
            "fax_number": "833-767-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6769 N WICKHAM RD # B101",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402048",
            "telephone_number": "321-525-1103",
            "fax_number": "833-767-2919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "930 S Harbor City Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329011901",
            "country_code": "US",
            "telephone_number": "321-241-4286",
            "fax_number": "833-767-2919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "M3 HAVEN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-25",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "MOSLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "321-525-1103"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health - Space Coast",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellie Mental Health - Space Coast",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.