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General NPI Number Information
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NPI Number | 1417332230
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Entity Type | Organization
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Legal Business Name | NEW LEAF THERAPY CENTER, LLC
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 1204 SE LOUIS DR
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City | MULVANE
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State | KS
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Zip | 67110-1113
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Country | US
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Telephone | 316-351-8696
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Fax | 844-581-0869
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Provider Business Mailing Address
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Address Line | 1204 SE LOUIS DR
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City | MULVANE
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State | KS
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Zip | 67110-1113
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Country | US
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Telephone | 316-351-8696
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Fax | 844-581-0869
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN DUTCHER
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Credential | PSYD, LP, LCMFT
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Telephone | 316-351-8696
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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 | 812
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1982
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License Number State | KS
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