Healthcare Provider Details

I. General information

NPI: 1609697754
Provider Name (Legal Business Name): STACY LYNN LEGGETT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 LELIA DR STE 220
JACKSON MS
39216-4832
US

IV. Provider business mailing address

123 SKYLANE DR
PEARL MS
39208-4242
US

V. Phone/Fax

Practice location:
  • Phone: 601-227-4006
  • Fax:
Mailing address:
  • Phone: 662-889-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3333
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: