Provider Demographics
NPI:1609433507
Name:TEMPLE LEGACY COUNSELING, LLC
Entity Type:Organization
Organization Name:TEMPLE LEGACY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:ROSEMARY
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DSW-LCSW
Authorized Official - Phone:267-258-8423
Mailing Address - Street 1:5137 N SCENIC HWY LOT 44
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-1900
Mailing Address - Country:US
Mailing Address - Phone:267-258-8423
Mailing Address - Fax:
Practice Address - Street 1:5137 N SCENIC HWY LOT 44
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-1900
Practice Address - Country:US
Practice Address - Phone:863-221-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty