Provider Demographics
NPI:1811596257
Name:LEAF MENTAL HEALTH INC
Entity Type:Organization
Organization Name:LEAF MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANJA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-299-3405
Mailing Address - Street 1:4270 BRIGHT BAY WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6000
Mailing Address - Country:US
Mailing Address - Phone:410-299-3405
Mailing Address - Fax:
Practice Address - Street 1:4270 BRIGHT BAY WAY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6000
Practice Address - Country:US
Practice Address - Phone:410-299-3405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty