Provider Demographics
NPI:1326307679
Name:NEW LEAF BEHAVIORAL SERVICES INC.
Entity Type:Organization
Organization Name:NEW LEAF BEHAVIORAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:478-954-4278
Mailing Address - Street 1:5137 RIVER EDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-9191
Mailing Address - Country:US
Mailing Address - Phone:478-954-4278
Mailing Address - Fax:321-396-7662
Practice Address - Street 1:5137 RIVER EDGE LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9191
Practice Address - Country:US
Practice Address - Phone:478-954-4278
Practice Address - Fax:321-396-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP12000041389251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health