Provider Demographics
NPI:1194335554
Name:NEW LEAF WELLNESS & BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:NEW LEAF WELLNESS & BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:219-973-7159
Mailing Address - Street 1:3430 E FLAMINGO RD STE 244
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5020
Mailing Address - Country:US
Mailing Address - Phone:219-973-7159
Mailing Address - Fax:
Practice Address - Street 1:3430 E FLAMINGO RD STE 244
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5020
Practice Address - Country:US
Practice Address - Phone:219-973-7159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)