Individual
MATT HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW LCSW, MS PA-C
Contact information
Practice address
1300 N OAKLAND AVE, SUITE A, BOLIVAR, MO 65613-3018
(417) 326-7676
(417) 326-3939
Mailing address
1500 N OAKLAND AVE, BOLIVAR, MO 65613-3011
(417) 326-6501
(417) 328-6338
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2005029085
MO
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
05/17/2007
Last updated
01/27/2017
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