Provider Demographics
NPI:1760827588
Name:NEW LEAF CENTER PLLC
Entity type:Organization
Organization Name:NEW LEAF CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-843-1500
Mailing Address - Street 1:1719 ASHLEY CIR STE 211
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5838
Mailing Address - Country:US
Mailing Address - Phone:270-843-1500
Mailing Address - Fax:888-371-4871
Practice Address - Street 1:1719 ASHLEY CIR STE 211
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5838
Practice Address - Country:US
Practice Address - Phone:270-843-1500
Practice Address - Fax:888-371-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty