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General NPI Number Information
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NPI Number | 1588107833
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Entity Type | Organization
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Legal Business Name | A NEW LEAF THERAPY LLC
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 100 E LINTON BLVD SUITE 103 B
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City | DELRAY BEACH
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State | FL
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Zip | 33483-3327
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Country | US
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Telephone | 954-328-8664
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E LINTON BLVD SUITE 103 B
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City | DELRAY BEACH
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State | FL
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Zip | 33483-3327
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Country | US
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Telephone | 954-328-8664
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | JULIE HUSSEY
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Credential |
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Telephone | 954-328-8664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 11461
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License Number State | FL
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