MEDICARE: NEW LEAF BEHAVIORAL HEALTH AND RECOVERY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1821961509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LEAF BEHAVIORAL HEALTH AND RECOVERY LLC

Provider Business Mailing Address
First Line	:	1539 E 93RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-8037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1539 E 93RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-8037
Country	:	US
Telephone Number	:	630-708-0795
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	VONISHA L BLACK
Credential	:	MSN APRN PMHNP-BC
Telephone Number	:	630-708-0795

Provider Enumeration Date	:	09/27/2025
Last Update Date	:	02/03/2026

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