Provider Demographics
NPI:1619612587
Name:NEW LEAF COUNSELING GROUP
Entity Type:Organization
Organization Name:NEW LEAF COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:SHUTTLESWORTH
Authorized Official - Last Name:SIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CDCA
Authorized Official - Phone:513-443-8790
Mailing Address - Street 1:11427 REED HARTMAN HWY STE 119
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2418
Mailing Address - Country:US
Mailing Address - Phone:513-443-8790
Mailing Address - Fax:
Practice Address - Street 1:11427 REED HARTMAN HWY STE 119
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2418
Practice Address - Country:US
Practice Address - Phone:513-443-8790
Practice Address - Fax:513-618-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0266404Medicaid