Basic Information
| Provider Information | |||||||||
| NPI: | 1235410408 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW LEAF BEHAVIORAL HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 719 SCOTT AVE STE 620 | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763012610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407619700 | ||||||||
| FaxNumber: | 9707619704 | ||||||||
| Practice Location | |||||||||
| Address1: | 719 SCOTT AVE STE 620 | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763012610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407619700 | ||||||||
| FaxNumber: | 9707619704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2011 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | NYBERG | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9407619700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.