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General NPI Number Information
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NPI Number | 1659884872
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Entity Type | Organization
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Legal Business Name | NEW LEAF CLINIC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 2910 W JEFFERSON ST
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City | LOUISVILLE
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State | KY
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Zip | 40212
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Country | US
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Telephone | 502-435-8321
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Fax |
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Provider Business Mailing Address
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Address Line | 13606 RUNNING SKY CT
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City | LOUISVILLE
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State | KY
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Zip | 40299-8446
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST/CEO
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Name | DR. TERESA WALKER
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Credential | MD
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Telephone | 502-851-3556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 48956
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License Number State | KY
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