Provider Demographics
NPI:1043966625
Name:NEW LEAF THERAPY PLLC
Entity Type:Organization
Organization Name:NEW LEAF THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:RYDER
Authorized Official - Last Name:KITZMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:507-208-8740
Mailing Address - Street 1:4526 COUNTY ROAD 3 SW
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-6208
Mailing Address - Country:US
Mailing Address - Phone:507-208-8740
Mailing Address - Fax:
Practice Address - Street 1:1130 1/2 7TH ST NW STE 208
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2995
Practice Address - Country:US
Practice Address - Phone:507-200-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty