Healthcare Provider Details

I. General information

NPI: 1720923469
Provider Name (Legal Business Name): NEW LEAF PSYCHIATRY & TMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4853 W GUMWOOD CIR
POST FALLS ID
83854-8210
US

IV. Provider business mailing address

4853 W GUMWOOD CIR
POST FALLS ID
83854-8210
US

V. Phone/Fax

Practice location:
  • Phone: 208-691-0287
  • Fax: 208-457-4171
Mailing address:
  • Phone: 208-691-0287
  • Fax: 208-457-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JOHANNA CHRISTINE MATTHEWS
Title or Position: OWNER / NURSE PRACTITIONER
Credential: ARNP, PMHNP-BC
Phone: 208-661-0677