Provider Demographics
NPI: | 1003526377 |
---|---|
Name: | NEW LEAF MENTAL HEALTH & WELLNESS, LLC |
Entity Type: | Organization |
Organization Name: | NEW LEAF MENTAL HEALTH & WELLNESS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | APRN |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANDREA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BALLUCH-DEAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PMHNP-BC |
Authorized Official - Phone: | 724-866-1750 |
Mailing Address - Street 1: | 143 BOARDMAN CANFIELD RD STE 324 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOARDMAN |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44512-4804 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3610 MERCEDES PL |
Practice Address - Street 2: | |
Practice Address - City: | CANFIELD |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44406-8139 |
Practice Address - Country: | US |
Practice Address - Phone: | 724-866-1750 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-11-28 |
Last Update Date: | 2022-11-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |