Provider Demographics
NPI:1225325251
Name:LEGACY THERAPEUTIC CONSULTING, LLC
Entity Type:Organization
Organization Name:LEGACY THERAPEUTIC CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:303-917-4145
Mailing Address - Street 1:2121 S BLACKHAWK ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1487
Mailing Address - Country:US
Mailing Address - Phone:303-917-4145
Mailing Address - Fax:
Practice Address - Street 1:2121 S BLACKHAWK ST
Practice Address - Street 2:SUITE 210
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1487
Practice Address - Country:US
Practice Address - Phone:303-917-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty