Healthcare Provider Details

I. General information

NPI: 1629774807
Provider Name (Legal Business Name): LEGACY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 FREASLANDS WAY
FRANKLIN KY
42134-7703
US

IV. Provider business mailing address

815 FREASLANDS WAY
FRANKLIN KY
42134-7703
US

V. Phone/Fax

Practice location:
  • Phone: 808-897-1375
  • Fax:
Mailing address:
  • Phone: 808-897-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AKIMI YARBROUGH
Title or Position: OWNER
Credential: OWNER
Phone: 808-897-1375