| Legendary Health Performance, Llc | |
|
86-058 Alta St Waianae HI 96792-3031 | |
| (808) 358-0800 | |
| Not Available |
| Full Name | Legendary Health Performance, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 86-058 Alta St, Waianae, Hawaii |
| Authorized Official Name and Position | Tiffany Jarae Wilson-landrum (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8083580800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legendary Health Performance, Llc Po Box 4055 Waianae HI 96792-7055 Ph: (808) 358-0800 | Legendary Health Performance, Llc 86-058 Alta St Waianae HI 96792-3031 Ph: (808) 358-0800 |
| NPI Number | 1730877812 |
|---|---|
| Provider Enumeration Date | 04/27/2023 |
| Last Update Date | 04/27/2023 |
| Certification Date | 04/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730877812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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