Healthcare Provider Details

I. General information

NPI: 1750246435
Provider Name (Legal Business Name): A NEW LEAF THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BROADWAY AVE
PUEBLO CO
81004-2104
US

IV. Provider business mailing address

327 COLORADO AVE
PUEBLO CO
81004-2005
US

V. Phone/Fax

Practice location:
  • Phone: 719-948-7120
  • Fax: 719-289-7144
Mailing address:
  • Phone: 719-948-7120
  • Fax: 719-289-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LINA NEW LEAF POULSON
Title or Position: HRM/OFFICE DIRECTOR
Credential:
Phone: 719-948-7120