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General NPI Number Information
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NPI Number | 1851379127
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Entity Type | Organization
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Legal Business Name | NEW LEAF FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4625 LINDELL BLVD SUITE 315
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3729
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Country | US
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Telephone | 314-629-9862
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 SHENANDOAH AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3513
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Country | US
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Telephone | 314-629-9862
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. MARYBETH GRAS
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Credential | LCSW
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Telephone | 314-629-9862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2001022248
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License Number State | MO
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