Provider Demographics
NPI:1710216387
Name:LEGACY COMPREHENSIVE COUNSELING & CONSULTING, PLLC
Entity Type:Organization
Organization Name:LEGACY COMPREHENSIVE COUNSELING & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-841-4005
Mailing Address - Street 1:9235 CROWN CREST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8881
Mailing Address - Country:US
Mailing Address - Phone:303-841-4005
Mailing Address - Fax:720-851-8379
Practice Address - Street 1:9235 CROWN CREST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8881
Practice Address - Country:US
Practice Address - Phone:303-841-4005
Practice Address - Fax:720-851-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty