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General NPI Number Information
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NPI Number | 1821961509
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Entity Type | Organization
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Legal Business Name | NEW LEAF BEHAVIORAL HEALTH AND RECOVERY LLC
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Dates
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Enumeration Date | 09/27/2025
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 1539 E 93RD ST
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City | CHICAGO
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State | IL
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Zip | 60619-8037
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Country | US
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Telephone | 630-708-0795
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Fax |
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Provider Business Mailing Address
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Address Line | 1539 E 93RD ST
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City | CHICAGO
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State | IL
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Zip | 60619-8037
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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 | NURSE PRACTITIONER
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Name | VONISHA L BLACK
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Credential | MSN APRN PMHNP-BC
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Telephone | 630-708-0795
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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