| New Leaf Institute Pllc | |
|
12906 E 106th St N Owasso OK 74055-5909 | |
| (918) 240-9380 | |
| (918) 376-4586 |
| Full Name | New Leaf Institute Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 12906 E 106th St N, Owasso, Oklahoma |
| Authorized Official Name and Position | Leslie Rose Riley (OWNER) |
| Authorized Official Contact | 9182409380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Leaf Institute Pllc 12906 E 106th St N Owasso OK 74055-5909 Ph: (918) 240-9380 | New Leaf Institute Pllc 12906 E 106th St N Owasso OK 74055-5909 Ph: (918) 240-9380 |
| NPI Number | 1295130508 |
|---|---|
| Provider Enumeration Date | 10/29/2014 |
| Last Update Date | 09/22/2015 |
| Medicare PECOS PAC ID | 6901124023 |
|---|---|
| Medicare Enrollment ID | O20150421000664 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295130508 | NPI | - | NPPES |
| 200579150A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TH0100X | Psychologist - Health Service | 1215 (Oklahoma) | Primary |
| Provider Name | Leslie R Riley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881656494 PECOS PAC ID: 9133144876 Enrollment ID: I20150421000907 |
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