Healthcare Provider Details

I. General information

NPI: 1508341280
Provider Name (Legal Business Name): JENNIFER LEGREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 REGATTA DR STE 102
LAS VEGAS NV
89128-6892
US

IV. Provider business mailing address

PO BOX 371541
LAS VEGAS NV
89137-1541
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-9710
  • Fax:
Mailing address:
  • Phone: 702-530-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: