Provider Demographics
NPI:1932877552
Name:CHILDREN'S LEGACY CENTER
Entity Type:Organization
Organization Name:CHILDREN'S LEGACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:KOHL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-768-1880
Mailing Address - Street 1:1110 SHASTA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0808
Mailing Address - Country:US
Mailing Address - Phone:530-768-1880
Mailing Address - Fax:
Practice Address - Street 1:1110 SHASTA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0808
Practice Address - Country:US
Practice Address - Phone:530-768-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health