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General NPI Number Information
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NPI Number | 1023107372
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Entity Type | Organization
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Legal Business Name | A NEW LEAF, INC.
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/20/2013
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Provider Practice Location Address
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Address Line | 8802 N 61ST AVE
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City | GLENDALE
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State | AZ
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Zip | 85302-4521
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Country | US
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Telephone | 623-934-1991
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Fax | 480-733-3031
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Provider Business Mailing Address
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Address Line | 868 E UNIVERSITY DR
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City | MESA
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State | AZ
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Zip | 85203-8033
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Country | US
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Telephone | 480-969-4024
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Fax | 480-969-0039
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL T. HUGHES
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Credential |
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Telephone | 480-969-4024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | BH2535
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | BH2535
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License Number State | AZ
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