Healthcare Provider Details

I. General information

NPI: 1407614043
Provider Name (Legal Business Name): NEW LEAF COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN ST
UNION CITY TN
38261-2131
US

IV. Provider business mailing address

196 PREACHER DOWLAND RD
KENTON TN
38233-3071
US

V. Phone/Fax

Practice location:
  • Phone: 731-599-9965
  • Fax:
Mailing address:
  • Phone: 731-445-0908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. GLEN MADISON TILGHMAN
Title or Position: OWNER
Credential: LCSW
Phone: 731-599-9965