Provider Demographics
NPI:1659672251
Name:LEGACY VALLEY COUNSELING
Entity Type:Organization
Organization Name:LEGACY VALLEY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-752-3106
Mailing Address - Street 1:1165 COUNTY ROAD 2699
Mailing Address - Street 2:
Mailing Address - City:LOMETA
Mailing Address - State:TX
Mailing Address - Zip Code:76853-3913
Mailing Address - Country:US
Mailing Address - Phone:512-752-3106
Mailing Address - Fax:512-752-4428
Practice Address - Street 1:19206 HUEBNER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3146
Practice Address - Country:US
Practice Address - Phone:210-497-2880
Practice Address - Fax:210-497-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty