PEDIATRIC HAVEN NPI 1043858053

NPI Information

NPI: 1043858053
Provider Name: PEDIATRIC HAVEN
Classification: Clinic/Center - 261QM0855X
Specialization: Adolescent and Children Mental Health
Entity Type: Organization
Doing Business As: PEDIATRIC HAVEN AUTISM CENTER
Address: 102 LEXINGTON DR
MADISON, MS
ZIP 39110
Phone: (601) 499-6696

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NPI Details

PEDIATRIC HAVEN is an adolescent and children mental health clinic center in Madison, MS. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. PEDIATRIC HAVEN NPI is 1043858053. The provider is registered as an organization entity type.
The provider Is Doing Business As Pediatric Haven Autism Center.

The provider's business location address is:

102 LEXINGTON DR
MADISON, MS
ZIP 39110-952
Phone: (601) 499-6696
Fax: (601) 499-6696

The provider's authorized official is Jetuwan M. Brown .
The authorized official title is Managing Partner and has the following contact phone number (601) 622-2997.

The enumeration date for this NPI number is 12/20/2019 and was last updated on 1/4/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QM3000X	Clinic/Center	Medically Fragile Infants and Children Day Care	No
2	3140N1450X	Skilled Nursing Facility	Nursing Care, Pediatric	No
3	103K00000X	Behavior Analyst		No
4	261QD1600X	Clinic/Center	Developmental Disabilities	No
5	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
6	385HR2055X	Respite Care	Respite Care, Mental Illness, Child	No
7	385HR2060X	Respite Care	Respite Care, Intellectual and/or Developmental Disabilities	No
8	385HR2065X	Respite Care	Respite Care, Physical Disabilities, Child	No
9	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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