| Pediatric Haven Autism Center | |
|
102 Lexington Dr Madison MS 39110-6952 | |
| (601) 499-6696 | |
| (601) 499-6696 |
| Full Name | Pediatric Haven Autism Center |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 102 Lexington Dr, Madison, Mississippi |
| Authorized Official Name and Position | Jetuwan M. Brown (MANAGING PARTNER) |
| Authorized Official Contact | 6016222997 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Haven Autism Center 103 Honours Dr Madison MS 39110-6513 Ph: (601) 622-2997 | Pediatric Haven Autism Center 102 Lexington Dr Madison MS 39110-6952 Ph: (601) 499-6696 |
| NPI Number | 1043858053 |
|---|---|
| Provider Enumeration Date | 12/20/2019 |
| Last Update Date | 01/04/2024 |
| Certification Date | 01/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043858053 | NPI | - | NPPES |
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