Provider Demographics
NPI:1255930533
Name:LEGACY LIFE COUNSELING & CONSULTING INC
Entity type:Organization
Organization Name:LEGACY LIFE COUNSELING & CONSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DEON
Authorized Official - Last Name:MORELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-212-4311
Mailing Address - Street 1:825 COLLEGE BLVD STE 102-336
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6263
Mailing Address - Country:US
Mailing Address - Phone:760-212-4311
Mailing Address - Fax:
Practice Address - Street 1:420 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7868
Practice Address - Country:US
Practice Address - Phone:760-212-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health