Provider Demographics
NPI:1235410408
Name:NEW LEAF BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:NEW LEAF BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-761-9700
Mailing Address - Street 1:719 SCOTT AVE STE 620
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-2610
Mailing Address - Country:US
Mailing Address - Phone:940-761-9700
Mailing Address - Fax:970-761-9704
Practice Address - Street 1:719 SCOTT AVE STE 620
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2610
Practice Address - Country:US
Practice Address - Phone:940-761-9700
Practice Address - Fax:970-761-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty