Basic Information
| Provider Information | |||||||||
| NPI: | 1609197631 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW LEAF COUNSELING SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 MILLER RD STE 7 | ||||||||
| Address2: | |||||||||
| City: | AVON LAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440121013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407421661 | ||||||||
| FaxNumber: | 4406539576 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 MILLER RD STE 7 | ||||||||
| Address2: | |||||||||
| City: | AVON LAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440121013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407421661 | ||||||||
| FaxNumber: | 4406539576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2010 | ||||||||
| LastUpdateDate: | 08/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | KONCILJA | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2163389088 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPCC | ||||||||
| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 090037 | OH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | E1000011 | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.