Provider Demographics
NPI:1417245028
Name:LEGACY FAMILY COUNSELING
Entity Type:Organization
Organization Name:LEGACY FAMILY COUNSELING
Other - Org Name:LEGACY FAMILY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:C.
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:MEERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:816-835-0520
Mailing Address - Street 1:632 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2908
Mailing Address - Country:US
Mailing Address - Phone:816-835-0520
Mailing Address - Fax:816-581-3725
Practice Address - Street 1:632 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2908
Practice Address - Country:US
Practice Address - Phone:816-835-0520
Practice Address - Fax:816-581-3725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-16
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011005980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty