| New Leaf Clinic | |
|
2910 W Jefferson St Louisville KY 40212 | |
| (502) 435-8321 | |
| Not Available |
| Full Name | New Leaf Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2910 W Jefferson St, Louisville, Kentucky |
| Authorized Official Name and Position | Teresa Walker (PSYCHIATRIST/CEO) |
| Authorized Official Contact | 5028513556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Leaf Clinic 13606 Running Sky Ct Louisville KY 40299-8446 Ph: () - | New Leaf Clinic 2910 W Jefferson St Louisville KY 40212 Ph: (502) 435-8321 |
| NPI Number | 1659884872 |
|---|---|
| Provider Enumeration Date | 11/09/2017 |
| Last Update Date | 06/22/2018 |
| Medicare PECOS PAC ID | 0244595924 |
|---|---|
| Medicare Enrollment ID | O20180530001066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659884872 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 48956 (Kentucky) | Primary |
| Provider Name | Teresa E Walker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417210824 PECOS PAC ID: 1153616255 Enrollment ID: I20160829002198 |
| Provider Name | Tiya Shalyse Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154696359 PECOS PAC ID: 6507148764 Enrollment ID: I20180223002247 |
| Provider Name | Latasha White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568930188 PECOS PAC ID: 7517292659 Enrollment ID: I20190711003353 |
| Provider Name | Alecia Eason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326701897 PECOS PAC ID: 3274923172 Enrollment ID: I20211208002876 |
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