Provider Demographics
NPI:1023583671
Name:NEWLEAF COUNSELING OF THE RIVER VALLEY
Entity type:Organization
Organization Name:NEWLEAF COUNSELING OF THE RIVER VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:O
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-228-2094
Mailing Address - Street 1:4108 HARDIE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-1143
Mailing Address - Country:US
Mailing Address - Phone:479-228-2094
Mailing Address - Fax:
Practice Address - Street 1:16135 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-7218
Practice Address - Country:US
Practice Address - Phone:479-996-5433
Practice Address - Fax:479-996-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty