Provider Demographics
NPI:1760021364
Name:NEW LEAF BEHAVIOR CENTER, LLC
Entity Type:Organization
Organization Name:NEW LEAF BEHAVIOR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, LABA
Authorized Official - Phone:360-500-3374
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0191
Mailing Address - Country:US
Mailing Address - Phone:360-500-3374
Mailing Address - Fax:360-612-0234
Practice Address - Street 1:418 E 1ST ST STE 104
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4116
Practice Address - Country:US
Practice Address - Phone:360-500-3374
Practice Address - Fax:360-612-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty