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BLK HAVEN CORP.
Complete NPI Record 1942936620
Counselor - Mental Health in Chula Vista, CA

NPI Status: Active since July 26, 2022

Contact Information

1079 CALLE DECEO
CHULA VISTA, CA
ZIP 91913
Phone: (763) 245-0390

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Middle Name
  22. Authorized Official Title or Position
  23. Authorized Official Telephone Number
  24. Healthcare Provider Taxonomy Code 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Is Organization Subpart
  27. Authorized Official Name Prefix Text
  28. Authorized Official Credential Text
  29. Healthcare Provider Taxonomy Group 1
  30. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1942936620. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1942936620
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The last name of the provider. If the provider is an individual, this is the legal name.
The first name of the provider, if the provider is an individual.
Provider First Line Business Mailing Address: 718 KIKANAI LOOP
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Business Mailing Address City Name: HONOLULU
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address State Name: HI
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 968184434
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7632450390
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 1079 CALLE DECEO
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: CHULA VISTA
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address State Name: CA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 919133345
The State code in the location of the provider being identified.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7632450390
The country code in the location address of the provider being identified.
Provider Enumeration Date: 7/26/2022
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/26/2022
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Last Name: WILSON
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: ASHLEE
The first name of the authorized official.
Authorized Official Middle Name: S
The middle name of the authorized official.
Authorized Official Title or Position: CEO/ CO-FOUNDER
The title or position of the authorized official.
Authorized Official Telephone Number: 7632450390
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 101YM0800X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MRS.
Authorized Official Credential Text: MS, LPCC
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP
NPI Certification Date: 7/26/2022