=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205528866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW LEAF FAMILY THERAPY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2023
-----------------------------------------------------
Last Update Date | 01/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 G ST STE G
-----------------------------------------------------
City | REEDLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93654-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-318-7123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 G ST STE G
-----------------------------------------------------
City | REEDLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93654-2629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-318-7123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HORACIO RENTERIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 559-318-7123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------