Provider Demographics
NPI:1780203265
Name:NEW LEAF MENTAL WELLNESS PLLC
Entity Type:Organization
Organization Name:NEW LEAF MENTAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:360-434-4783
Mailing Address - Street 1:12139 GLENWOOD RD SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7756
Mailing Address - Country:US
Mailing Address - Phone:360-769-3639
Mailing Address - Fax:
Practice Address - Street 1:12139 GLENWOOD RD SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7756
Practice Address - Country:US
Practice Address - Phone:360-769-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty