| Legacy Assessment Group, Llc | |
|
1341 W Mockingbird Ln Ste 760 Dallas TX 75247-6913 | |
| (214) 760-1964 | |
| (214) 760-9505 |
| Full Name | Legacy Assessment Group, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1341 W Mockingbird Ln Ste 760, Dallas, Texas |
| Authorized Official Name and Position | Michael Jafarzadeh (OWNER) |
| Authorized Official Contact | 2147601964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Assessment Group, Llc 1341 W Mockingbird Ln Ste 760 Dallas TX 75247-6913 Ph: (214) 760-1964 | Legacy Assessment Group, Llc 1341 W Mockingbird Ln Ste 760 Dallas TX 75247-6913 Ph: (214) 760-1964 |
| NPI Number | 1316211436 |
|---|---|
| Provider Enumeration Date | 03/07/2012 |
| Last Update Date | 08/13/2024 |
| Certification Date | 08/13/2024 |
| Medicare PECOS PAC ID | 1658667001 |
|---|---|
| Medicare Enrollment ID | O20160910000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316211436 | NPI | - | NPPES |
| 309543201 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 24635 (Texas) | Primary |
| Provider Name | Michael Jafarzadeh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922544113 PECOS PAC ID: 4789967787 Enrollment ID: I20170217001588 |
| Provider Name | Martika Channel Jones |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629757299 PECOS PAC ID: 9537522461 Enrollment ID: I20230825000586 |
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