Healthcare Provider Details

I. General information

NPI: 1578048815
Provider Name (Legal Business Name): NEW LEAF COUNSELING SERVICES OF THE TN VALLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SUN TEMPLE DR STE C1
MADISON AL
35758-5925
US

IV. Provider business mailing address

113 WHIRLAWAY DR
MADISON AL
35756-4289
US

V. Phone/Fax

Practice location:
  • Phone: 256-755-4599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALICIA SCHUSTER-COUCH
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 256-755-4599