Provider Demographics
NPI:1578199691
Name:LEGGETT, CAITLIN ALEXANDRA
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:ALEXANDRA
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 FOUNTAINSIDE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7840
Mailing Address - Country:US
Mailing Address - Phone:901-930-7397
Mailing Address - Fax:901-244-6528
Practice Address - Street 1:3085 FOUNTAINSIDE DR STE 110
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7840
Practice Address - Country:US
Practice Address - Phone:901-930-7397
Practice Address - Fax:901-244-6528
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional