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General NPI Number Information
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NPI Number | 1043966625
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Entity Type | Organization
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Legal Business Name | NEW LEAF THERAPY PLLC
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 1130 1/2 7TH ST NW STE 208
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City | ROCHESTER
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State | MN
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Zip | 55901-2995
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Country | US
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Telephone | 507-200-0224
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Fax |
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Provider Business Mailing Address
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Address Line | 4526 COUNTY ROAD 3 SW
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City | BYRON
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State | MN
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Zip | 55920-6208
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Country | US
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Telephone | 507-208-8740
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KELSEY RYDER KITZMANN
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Credential | LMFT
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Telephone | 507-208-8740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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