Provider Demographics
NPI:1972291524
Name:LEGACY COUNSELING & LIFE COACHING LLC
Entity Type:Organization
Organization Name:LEGACY COUNSELING & LIFE COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PITTS-BOUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMFT
Authorized Official - Phone:833-574-8878
Mailing Address - Street 1:539 W COMMERCE ST STE 8246
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1953
Mailing Address - Country:US
Mailing Address - Phone:833-574-8878
Mailing Address - Fax:
Practice Address - Street 1:2201 N COLLINS STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011
Practice Address - Country:US
Practice Address - Phone:833-574-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty