| Legacy Counseling Center Inc | |
|
4054 Mckinney Ave Ste 102 Dallas TX 75204-2050 | |
| (214) 520-6308 | |
| Not Available |
| Full Name | Legacy Counseling Center Inc |
|---|---|
| Speciality | Social Worker |
| Location | 4054 Mckinney Ave Ste 102, Dallas, Texas |
| Authorized Official Name and Position | Melissa Grove (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2145206308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Counseling Center Inc 4054 Mckinney Ave Ste 102 Dallas TX 75204-2050 Ph: (214) 520-6308 | Legacy Counseling Center Inc 4054 Mckinney Ave Ste 102 Dallas TX 75204-2050 Ph: (214) 520-6308 |
| NPI Number | 1770510075 |
|---|---|
| Provider Enumeration Date | 06/26/2006 |
| Last Update Date | 05/31/2017 |
| Medicare PECOS PAC ID | 7416931829 |
|---|---|
| Medicare Enrollment ID | O20040615000189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770510075 | NPI | - | NPPES |
| 55GT | Other | BCBS | |
| 079683102 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | S18803 (Texas) | Primary |
| Provider Name | Peter Brook Wilkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972526010 PECOS PAC ID: 1658315866 Enrollment ID: I20050617000294 |
| Provider Name | Joanne Spears |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720237514 PECOS PAC ID: 5799845657 Enrollment ID: I20081121000332 |
| Provider Name | Joseph D Cobb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265854012 PECOS PAC ID: 6305120106 Enrollment ID: I20170222002023 |
| Provider Name | Gail E Atwater |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477975407 PECOS PAC ID: 0143584193 Enrollment ID: I20180430000227 |
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