Healthcare Provider Details

I. General information

NPI: 1619161023
Provider Name (Legal Business Name): NEW LEAF ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 BUTCH CASSIDY DR
BOZEMAN MT
59718-9310
US

IV. Provider business mailing address

2115 DURSTON RD
BOZEMAN MT
59718-2800
US

V. Phone/Fax

Practice location:
  • Phone: 406-579-7101
  • Fax: 866-317-3940
Mailing address:
  • Phone: 406-586-2159
  • Fax: 866-317-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number30177
License Number StateMT

VIII. Authorized Official

Name: LINDA KEDDINGTON
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: APRN
Phone: 406-579-7101