NPIMap

Organization Active NPI

A New Leaf Therapy, LLC

  • Psychologist
  • Pueblo, CO
National Provider Identifier
1063868263
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY3290 Issued in CO
Legal business name
A NEW LEAF THERAPY, LLC
Practice address
315 Colorado Ave
Pueblo, CO 81004-2046
Phone
(719) 948-7120
Fax
(719) 289-7144
NPI assigned
May 6, 2016
Last updated
May 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

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

Authorized official

Name
Regan Young, LCSW, CACIIINPI 1871918037
Title
Owner/Psychotherapist
Phone
(719) 948-7120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X PSY3290 CO
Psychologist 103T00000X PSY3290 CO Primary

Addresses

Primary practice location

315 Colorado Ave
Pueblo, CO 81004-2046

Mailing address

315 Colorado Ave
Pueblo, CO 81004-2046
Phone (719) 948-7120

National Provider Directory

National Provider Directory
Tax ID family
A New Leaf Therapy LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462492800000",
    "number": "1063868263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 COLORADO AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042046",
            "telephone_number": "719-948-7120",
            "fax_number": "719-289-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 COLORADO AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042046",
            "telephone_number": "719-948-7120",
            "fax_number": "719-289-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A NEW LEAF THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-06",
        "last_updated": "2016-05-06",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "REGAN",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "719-948-7120",
        "authorized_official_credential": "LCSW, CACIII"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CO",
            "license": "PSY3290",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY3290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2016; 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.