Organization
HAVEN BEHAVIORAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRK MCCONNELL (VP)
(719) 640-5445
Entity
Organization
Contact information
Practice address
1330 QUAIL LAKE LOOP, SUITE 240, COLORADO SPRINGS, CO 80906-4651
(719) 640-5445
Mailing address
9420 S AVERS AVE, EVERGREEN PARK, IL 60805-2007
(708) 285-0578
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-14-5932
IL
Other
Enumeration date
05/21/2014
Last updated
05/21/2014
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