| A New Leaf Therapy, Pllc | |
|
327 Colorado Ave Pueblo CO 81004 | |
| (719) 948-7120 | |
| (719) 289-7144 |
| Full Name | A New Leaf Therapy, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 327 Colorado Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Regan Young (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 7199487120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A New Leaf Therapy, Pllc 6192 Muddy Creek Rd Pueblo CO 81004-9747 Ph: (719) 948-7120 | A New Leaf Therapy, Pllc 327 Colorado Ave Pueblo CO 81004 Ph: (719) 948-7120 |
| NPI Number | 1194111500 |
|---|---|
| Provider Enumeration Date | 04/13/2015 |
| Last Update Date | 07/18/2018 |
| Medicare PECOS PAC ID | 8628346582 |
|---|---|
| Medicare Enrollment ID | O20170616001780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194111500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1759 (Colorado) | Primary |
| 251S00000X | Community/behavioral Health | 6858 (Colorado) | Secondary |
| Provider Name | Ronald L Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194162685 PECOS PAC ID: 2466469820 Enrollment ID: I20060310000136 |
| Provider Name | Regan A Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871918037 PECOS PAC ID: 8123345394 Enrollment ID: I20150327000362 |
| Provider Name | Kimberly Coffman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376044594 PECOS PAC ID: 9234487935 Enrollment ID: I20180810002238 |
| Provider Name | Rachel Donohue-dupler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720593395 PECOS PAC ID: 1153751094 Enrollment ID: I20200417000359 |
| Provider Name | Crystal Gerlock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558917898 PECOS PAC ID: 9032526801 Enrollment ID: I20210323000018 |
| Provider Name | Taylor Haydee Lopez-cepero |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1841944246 PECOS PAC ID: 6507252442 Enrollment ID: I20220401001496 |
| Provider Name | Marilyn H Laughlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386166783 PECOS PAC ID: 6204106966 Enrollment ID: I20220510000771 |
| Provider Name | Stephanie Mastroantonio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235710245 PECOS PAC ID: 4082087291 Enrollment ID: I20230308001158 |
| Provider Name | Rachel Hadaway Aguirre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457052789 PECOS PAC ID: 1658745062 Enrollment ID: I20230327002437 |
| Provider Name | Halie Irene Alexander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831720606 PECOS PAC ID: 9032564307 Enrollment ID: I20231006002571 |
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