Provider Demographics
NPI:1508220310
Name:NEW LEAF INTEGRATIVE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:NEW LEAF INTEGRATIVE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:520-261-1003
Mailing Address - Street 1:3349 S TWILIGHT ECHO RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85735-5120
Mailing Address - Country:US
Mailing Address - Phone:520-261-1003
Mailing Address - Fax:
Practice Address - Street 1:145 E UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7738
Practice Address - Country:US
Practice Address - Phone:520-261-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health