Healthcare Provider Details

I. General information

NPI: 1124984398
Provider Name (Legal Business Name): TEMPLE LEGACY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 US HIGHWAY 550 UNIT 1803
CUBA NM
87013-1455
US

IV. Provider business mailing address

6437 US HIGHWAY 550 UNIT 1803
CUBA NM
87013-1455
US

V. Phone/Fax

Practice location:
  • Phone: 206-408-3046
  • Fax:
Mailing address:
  • Phone: 206-408-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SABRINA GONZALEZ
Title or Position: CEO/OWNER
Credential:
Phone: 206-408-3046