Healthcare Provider Details

I. General information

NPI: 1245155191
Provider Name (Legal Business Name): SILVER LEAF THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SE BAYA DR STE 105
LAKE CITY FL
32025-6092
US

IV. Provider business mailing address

1633 NW NASH RD
LAKE CITY FL
32055-8010
US

V. Phone/Fax

Practice location:
  • Phone: 406-461-1656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAVID PATRICK
Title or Position: OWNER
Credential: LCSW
Phone: 352-328-6219