Provider Demographics
NPI:1265619746
Name:LARRY T LEGG II LCSW LLC
Entity type:Organization
Organization Name:LARRY T LEGG II LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:LEGG
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-965-2800
Mailing Address - Street 1:1820 LATELIA CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4907
Mailing Address - Country:US
Mailing Address - Phone:813-965-2800
Mailing Address - Fax:813-933-4265
Practice Address - Street 1:8019 N HIMES AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2712
Practice Address - Country:US
Practice Address - Phone:813-965-2800
Practice Address - Fax:813-933-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-27
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 5685251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ063YZMedicare UPIN