Organization
HAVEN HOUSE
Active
Other names
Safe Haven Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA OLSON MS, LCSW (CLINICAL COORDINATOR)
(715) 339-6453
Entity
Organization
Contact information
Practice address
548 N LAKE AVE, PHILLIPS, WI 54555-1028
(715) 339-6453
Mailing address
548 N LAKE AVE, PHILLIPS, WI 54555-1028
(715) 339-6453
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
57598-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42255200
—
WI
Enumeration date
09/28/2011
Last updated
09/28/2011
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