Healthcare Provider Details

I. General information

NPI: 1013647023
Provider Name (Legal Business Name): NEW LEAF MARRIAGE & FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2489 TAPO ST STE B
SIMI VALLEY CA
93063-2453
US

IV. Provider business mailing address

2489 TAPO ST STE B
SIMI VALLEY CA
93063-2453
US

V. Phone/Fax

Practice location:
  • Phone: 805-774-1506
  • Fax:
Mailing address:
  • Phone: 805-774-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NATALIE ANNE BOLOGNA
Title or Position: COMPANY PRESIDENT
Credential: LMFT
Phone: 805-774-1506