Dallas New Leaf Clinic

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

20192 Issued in TX

Legal business name

DALLAS NEW LEAF CLINIC

Practice address

17103 Preston Rd
Suite 288
Dallas, TX 75248-1332

Phone

(469) 251-0803

NPI assigned

Feb 4, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jennifer Lynn Dougherty, PHDNPI 1669707097

Title

Assessment Counselor

Phone

(469) 251-0803

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Lynn Dougherty, PH.D.

  • Counselor
  • Dallas, TX
  • NPI 1669707097
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423008000000",
    "number": "1043600596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17103 PRESTON RD",
            "address_2": "SUITE 288",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481332",
            "telephone_number": "469-251-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17103 PRESTON RD",
            "address_2": "SUITE 288",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481332",
            "telephone_number": "469-251-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS NEW LEAF CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2015-02-04",
        "status": "A",
        "authorized_official_last_name": "DOUGHERTY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "ASSESSMENT COUNSELOR",
        "authorized_official_telephone_number": "469-251-0803",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "20192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.