Blu Haven Wellness Center, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

BLU HAVEN WELLNESS CENTER, LLC

Practice address

3520 Sugarloaf Parkway
F 03-66
Frederick, MD 21704

Phone

(301) 824-9890

NPI assigned

Dec 16, 2021

Organization subpart

No

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

Authorized official

Name

Monique Harris, LCPC

Title

Manager

Phone

(301) 824-9890

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639612800000",
    "number": "1902565948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 SUGARLOAF PARKWAY",
            "address_2": "F 03-66",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21704",
            "telephone_number": "301-824-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 SUGARLOAF PARKWAY",
            "address_2": "F 03-66",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "21704",
            "telephone_number": "301-824-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLU HAVEN WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "301-824-9890",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; 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.