Provider Demographics
NPI:1841936366
Name:PENNIE JO LEGGETT
Entity type:Organization
Organization Name:PENNIE JO LEGGETT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:928-916-7065
Mailing Address - Street 1:107 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4209
Mailing Address - Country:US
Mailing Address - Phone:928-916-7065
Mailing Address - Fax:
Practice Address - Street 1:3228 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3500
Practice Address - Country:US
Practice Address - Phone:423-370-3010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-08
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty