Healthcare Provider Details

I. General information

NPI: 1497117980
Provider Name (Legal Business Name): NEW LEAF SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E HWY 377 SUITE 104
GRANBURY TX
76048-1242
US

IV. Provider business mailing address

911 E HWY 377 SUITE 104
GRANBURY TX
76048-1242
US

V. Phone/Fax

Practice location:
  • Phone: 855-579-5323
  • Fax: 855-579-5323
Mailing address:
  • Phone: 855-579-5323
  • Fax: 855-579-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DUNCAN
Title or Position: BILLING AND CREDENTIALING
Credential:
Phone: 855-579-5323