NPIMap

Organization Active NPI

BLK Haven Corp.

  • Mental Health Counselor
  • Chula Vista, CA
National Provider Identifier
1942936620
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
BLK HAVEN CORP.
Practice address
1079 Calle Deceo
Chula Vista, CA 91913-3345
Phone
(763) 245-0390
NPI assigned
Jul 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Authorized official

Name
Mrs. Ashlee S Wilson, MS, LPCCNPI 1760064323
Title
Ceo/ Co-Founder
Phone
(763) 245-0390

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 Primary

Addresses

Primary practice location

1079 Calle Deceo
Chula Vista, CA 91913-3345

Mailing address

718 Kikanai Loop
Honolulu, HI 96818-4434
Phone (763) 245-0390

Other names 1

  • BLK Haven Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://secure.simplepractice.com/users/sign_in Direct

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": "1658793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1942936620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 KIKANAI LOOP",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968184434",
            "telephone_number": "763-245-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1079 CALLE DECEO",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919133345",
            "telephone_number": "763-245-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLK HAVEN CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ASHLEE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO/ CO-FOUNDER",
        "authorized_official_telephone_number": "763-245-0390",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, LPCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://secure.simplepractice.com/users/sign_in",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1079 Calle Deceo",
            "city": "Chula Vista",
            "state": "CA",
            "country_code": "US",
            "postal_code": "919133345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BLK Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; 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.