MEDICARE: NEW LIFE INSTITUTE OF MENTAL AND BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619800562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE INSTITUTE OF MENTAL AND BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	76 S TECUMSEH RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-4220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 S TECUMSEH RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-4220
Country	:	US
Telephone Number	:	937-303-1096
Fax Number	:

Authorized Official
Title or Position	:	DIRECRTOR
Name	:	MICHAEL BRANDON BLUE
Credential	:	MA, LPCC, NCC
Telephone Number	:	618-697-5656

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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