| Mental Haven, Llc | |
|
3630 S Perry St Montgomery AL 36105-2203 | |
| (334) 625-0779 | |
| (334) 888-8599 |
| Full Name | Mental Haven, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3630 S Perry St, Montgomery, Alabama |
| Authorized Official Name and Position | Danel Whitehead (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 3133000567 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Haven, Llc 3066 Zelda Rd Montgomery AL 36106-2651 Ph: (313) 300-0567 | Mental Haven, Llc 3630 S Perry St Montgomery AL 36105-2203 Ph: (334) 625-0779 |
| NPI Number | 1124760624 |
|---|---|
| Provider Enumeration Date | 04/13/2022 |
| Last Update Date | 10/10/2023 |
| Certification Date | 10/09/2023 |
| Medicare PECOS PAC ID | 5294115796 |
|---|---|
| Medicare Enrollment ID | O20220630000192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124760624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Danel Whitehead |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578930830 PECOS PAC ID: 6103206602 Enrollment ID: I20220630000227 |
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