Provider Demographics
NPI:1255720629
Name:LEGGETT, PAMELA (LMHC, CRC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:LMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7491 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2811
Mailing Address - Country:US
Mailing Address - Phone:954-205-1127
Mailing Address - Fax:954-827-0802
Practice Address - Street 1:7491 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2811
Practice Address - Country:US
Practice Address - Phone:954-205-1127
Practice Address - Fax:954-827-0802
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health