Organization
NEW LEAF INSTITUTE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE ROSE RILEY PSYD (OWNER)
(918) 240-9380
Entity
Organization
Contact information
Practice address
12906 E 106TH ST N, OWASSO, OK 74055-5909
(918) 240-9380
(918) 376-4586
Mailing address
12906 E 106TH ST N, OWASSO, OK 74055-5909
(918) 240-9380
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
1215
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200579150A
—
OK
Enumeration date
10/29/2014
Last updated
09/22/2015
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