Provider Demographics
NPI:1093242893
Name:NEW LEAF THERAPY LLC
Entity Type:Organization
Organization Name:NEW LEAF THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:712-441-6591
Mailing Address - Street 1:15 1ST AVE NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3555
Mailing Address - Country:US
Mailing Address - Phone:712-441-6591
Mailing Address - Fax:
Practice Address - Street 1:15 1ST AVE NW
Practice Address - Street 2:SUITE B
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3555
Practice Address - Country:US
Practice Address - Phone:712-441-6591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03668251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health