Provider Demographics
NPI:1063829174
Name:NEW LEAF PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:NEW LEAF PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:IRMGARD
Authorized Official - Last Name:ALEXAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-960-1163
Mailing Address - Street 1:2172 TECHNY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6635
Mailing Address - Country:US
Mailing Address - Phone:773-960-1163
Mailing Address - Fax:224-415-3911
Practice Address - Street 1:2172 TECHNY RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6635
Practice Address - Country:US
Practice Address - Phone:773-960-1163
Practice Address - Fax:224-415-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008103103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty