Healthcare Provider Details

I. General information

NPI: 1578276358
Provider Name (Legal Business Name): THOMAS GREENLEAF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE # 211
ALBUQUERQUE NM
87109-3179
US

IV. Provider business mailing address

1208 DR. MLK JR. AVE NE #4
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-7771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0109
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: