Provider Demographics
NPI:1235955584
Name:HAVEN PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:HAVEN PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:DR
Authorized Official - First Name:KAILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:623-466-4870
Mailing Address - Street 1:20019 W MAZATZAL DR
Mailing Address - Street 2:
Mailing Address - City:WITTMANN
Mailing Address - State:AZ
Mailing Address - Zip Code:85361-5015
Mailing Address - Country:US
Mailing Address - Phone:623-466-4870
Mailing Address - Fax:
Practice Address - Street 1:20019 W MAZATZAL DR
Practice Address - Street 2:
Practice Address - City:WITTMANN
Practice Address - State:AZ
Practice Address - Zip Code:85361-5015
Practice Address - Country:US
Practice Address - Phone:623-850-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty