Healthcare Provider Details

I. General information

NPI: 1437041837
Provider Name (Legal Business Name): LEGACY CONSULTING AND COUNSELING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 NW NORTH MACEDO BLVD STE 286
PORT ST LUCIE FL
34983-1428
US

IV. Provider business mailing address

5265 NW NORTH MACEDO BLVD
PORT ST LUCIE FL
34983-1428
US

V. Phone/Fax

Practice location:
  • Phone: 772-237-9957
  • Fax:
Mailing address:
  • Phone: 772-237-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: BARBARA GEFFRAND
Title or Position: OWNER
Credential:
Phone: 772-237-9957