Healthcare Provider Details

I. General information

NPI: 1922567817
Provider Name (Legal Business Name): A NEW LEAF, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2254 W MAIN ST
MESA AZ
85201-6847
US

IV. Provider business mailing address

868 E UNIVERSITY DR
MESA AZ
85203-8033
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-4024
  • Fax:
Mailing address:
  • Phone: 480-969-4024
  • Fax: 480-969-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN BECKSTEAD
Title or Position: DIRECTOR OF INFORMATICS
Credential:
Phone: 480-848-6088