Healthcare Provider Details

I. General information

NPI: 1841936366
Provider Name (Legal Business Name): PENNIE JO LEGGETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2022
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 BRAINERD RD
CHATTANOOGA TN
37411-3500
US

IV. Provider business mailing address

107 ELMWOOD DR
CHATTANOOGA TN
37411-4209
US

V. Phone/Fax

Practice location:
  • Phone: 423-370-3010
  • Fax:
Mailing address:
  • Phone: 928-916-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PENNIE LEGGETT
Title or Position: DIRECTOR/CLINICIAN
Credential: MA LMFT
Phone: 928-916-7065