Basic Information
Provider Information
NPI: 1154783355
EntityType: 2
ReplacementNPI:  
OrganizationName: NEW LEAF COUNSELING SERVICES PLLC
LastName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: PO BOX 10
Address2:  
City: MASON
State: MI
PostalCode: 488540010
CountryCode: US
TelephoneNumber: 5176769788
FaxNumber: 5176763438
Practice Location
Address1: 211 MAPLE ST
Address2:  
City: BIG RAPIDS
State: MI
PostalCode: 493073215
CountryCode: US
TelephoneNumber: 9899445735
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/25/2016
LastUpdateDate: 03/25/2016
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: WERNETTE
AuthorizedOfficialFirstName: ANGELA
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 9899445735
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: LPC
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X6401012948MIY193400000X SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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