NPI 1063868263 · live from the CMS NPI Registry
A New Leaf Therapy, LLC
Psychologist in Pueblo, CO. National Provider Identifier 1063868263, active.
NPI record
| NPI | 1063868263 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Psychologist 103T00000X |
| Practice location | 315 Colorado Ave, Pueblo, CO 81004 |
| Practice phone | 719-948-7120 |
| Enumerated | May 6, 2016 |
| Last updated | May 6, 2016 |
| Authorized official | Regan Young, Owner/Psychotherapist |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinic/Center, Adult Mental Health | 261QM0850X | psy3290 (CO) |
| Psychologist primary | 103T00000X | psy3290 (CO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.