Healthcare Provider Details

I. General information

NPI: 1619800562
Provider Name (Legal Business Name): NEW LIFE INSTITUTE OF MENTAL AND BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

76 S TECUMSEH RD
SPRINGFIELD OH
45506-4220
US

IV. Provider business mailing address

76 S TECUMSEH RD
SPRINGFIELD OH
45506-4220
US

V. Phone/Fax

Practice location:
  • Phone: 937-303-1096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BRANDON BLUE
Title or Position: DIRECRTOR
Credential: MA, LPCC, NCC
Phone: 618-697-5656