Provider Demographics
NPI:1225766926
Name:LEGACY CENTER, PLLC
Entity Type:Organization
Organization Name:LEGACY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLYE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:901-610-0423
Mailing Address - Street 1:140 S MAIN ST STE 28
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3044
Mailing Address - Country:US
Mailing Address - Phone:901-610-0423
Mailing Address - Fax:901-610-0432
Practice Address - Street 1:140 S MAIN ST STE 28
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3044
Practice Address - Country:US
Practice Address - Phone:901-610-0423
Practice Address - Fax:901-610-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty