Provider Demographics
NPI:1407614043
Name:NEW LEAF COUNSELING, LLC
Entity Type:Organization
Organization Name:NEW LEAF COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:TILGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:731-599-9965
Mailing Address - Street 1:196 PREACHER DOWLAND RD
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38233-3071
Mailing Address - Country:US
Mailing Address - Phone:731-445-0908
Mailing Address - Fax:
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-2131
Practice Address - Country:US
Practice Address - Phone:731-599-9965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ089173Medicaid