Provider Demographics
NPI:1700147113
Name:THE LEGACY COMPLEX, INC
Entity Type:Organization
Organization Name:THE LEGACY COMPLEX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:HICKS
Authorized Official - Last Name:SPITLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:325-669-1922
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1599
Mailing Address - Country:US
Mailing Address - Phone:325-669-1922
Mailing Address - Fax:325-676-7878
Practice Address - Street 1:4301 N DANVILLE DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-9259
Practice Address - Country:US
Practice Address - Phone:325-669-1922
Practice Address - Fax:325-676-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health