Healthcare Provider Details

I. General information

NPI: 1902375801
Provider Name (Legal Business Name): A NEW LEAF MENTAL HEALTH & WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 COUNCIL ST NE STE 117
CEDAR RAPIDS IA
52402-5860
US

IV. Provider business mailing address

5925 COUNCIL ST NE STE 117
CEDAR RAPIDS IA
52402-5860
US

V. Phone/Fax

Practice location:
  • Phone: 319-423-0919
  • Fax:
Mailing address:
  • Phone: 319-423-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MISS JENNINE MERRIAM SEEDE
Title or Position: CEO
Credential:
Phone: 319-423-0919