Provider Demographics
NPI:1962844993
Name:THE LEGACY WORKSHOP LLC
Entity Type:Organization
Organization Name:THE LEGACY WORKSHOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-531-5507
Mailing Address - Street 1:8215 CORA ST
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-3212
Mailing Address - Country:US
Mailing Address - Phone:818-531-5507
Mailing Address - Fax:
Practice Address - Street 1:8215 CORA ST
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-3212
Practice Address - Country:US
Practice Address - Phone:818-531-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS13585251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health