| NPI | 1336770627 |
|---|---|
| Doing Business As | LEGACY'S IMPACT INTERVENTION L.L.C |
| Entity Type | Organization |
| Authorized Contact | SHONTA CROWDER Director/Therapist 918-766-6998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2020-01-27 |