Provider Demographics
NPI:1134914104
Name:NEW LEAF THERAPY LLC
Entity type:Organization
Organization Name:NEW LEAF THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CORVELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-769-1024
Mailing Address - Street 1:262 KING RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8503
Mailing Address - Country:US
Mailing Address - Phone:662-769-1024
Mailing Address - Fax:
Practice Address - Street 1:262 KING RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8503
Practice Address - Country:US
Practice Address - Phone:662-769-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health