MEDICARE: LEAF MENTAL HEALTH INC

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	:	1811596257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAF MENTAL HEALTH INC

Provider Business Mailing Address
First Line	:	4270 BRIGHT BAY WAY
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-6000
Country	:	US
Telephone Number	:	410-299-3405
Fax Number	:

Provider Business Practice Location Address
First Line	:	4270 BRIGHT BAY WAY
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-6000
Country	:	US
Telephone Number	:	410-299-3405
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ANJA DUNPHY
Credential	:
Telephone Number	:	410-299-3405

Provider Enumeration Date	:	10/17/2020
Last Update Date	:	10/17/2020

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