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General NPI Number Information
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NPI Number | 1326307679
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Entity Type | Organization
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Legal Business Name | NEW LEAF BEHAVIORAL SERVICES INC.
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 5137 RIVER EDGE LN
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City | LEESBURG
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State | FL
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Zip | 34748-9191
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Country | US
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Telephone | 478-954-4278
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Fax | 321-396-7662
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Provider Business Mailing Address
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Address Line | 5137 RIVER EDGE LN
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City | LEESBURG
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State | FL
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Zip | 34748-9191
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Country | US
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Telephone | 478-954-4278
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Fax | 321-396-7662
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORDAN L HOLT
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Credential | M.S., BCBA
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Telephone | 478-954-4278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | P12000041389
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License Number State | FL
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