Provider Demographics
NPI:1467129312
Name:LEGIONARY MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:LEGIONARY MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:360-773-7760
Mailing Address - Street 1:4400 NE 77TH AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6829
Mailing Address - Country:US
Mailing Address - Phone:360-773-7760
Mailing Address - Fax:
Practice Address - Street 1:4400 NE 77TH AVE STE 221
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6829
Practice Address - Country:US
Practice Address - Phone:360-773-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty