| Icon Legacy Group Llc | |
|
802 Switzer Ln Cedar Hill TX 75104-7254 | |
| (214) 803-4512 | |
| Not Available |
| Full Name | Icon Legacy Group Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 802 Switzer Ln, Cedar Hill, Texas |
| Authorized Official Name and Position | Michelle Wagner (CEO) |
| Authorized Official Contact | 2148034512 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icon Legacy Group Llc 802 Switzer Ln Cedar Hill TX 75104-7254 Ph: (214) 803-4512 | Icon Legacy Group Llc 802 Switzer Ln Cedar Hill TX 75104-7254 Ph: (214) 803-4512 |
| NPI Number | 1558948364 |
|---|---|
| Provider Enumeration Date | 03/26/2021 |
| Last Update Date | 03/26/2021 |
| Certification Date | 03/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558948364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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