Healthcare Provider Details

I. General information

NPI: 1023940079
Provider Name (Legal Business Name): NEW LEAF MENTAL HEALTH & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W CANAL ST
PICAYUNE MS
39466-3951
US

IV. Provider business mailing address

417 W CANAL ST
PICAYUNE MS
39466-3951
US

V. Phone/Fax

Practice location:
  • Phone: 601-916-0665
  • Fax:
Mailing address:
  • Phone: 601-864-1336
  • Fax: 949-946-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEVEN FEJKA CAMERON
Title or Position: OWNER/PROVIDER
Credential: FNP-C, PMHNP-C
Phone: 601-864-1336