MEDICARE: MRS. KACIE S LEGAYE LCSW-S, LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13949	TX
2	1041C0700X	Clinical Social Worker	59229	TX

General Provider Information

NPI Number	:	1033656509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KACIE S LEGAYE LCSW-S, LCDC

Provider Business Mailing Address
First Line	:	3541 FALCON WAY
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-4880
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-1000
Country	:	US
Telephone Number	:	713-329-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	09/17/2024

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