Healthcare Provider Details

I. General information

NPI: 1669337374
Provider Name (Legal Business Name): ILEGACY CONSULTING AND COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 ROSEBROOK DR
MANSFIELD TX
76063-7503
US

IV. Provider business mailing address

1311 ROSEBROOK DR
MANSFIELD TX
76063-7503
US

V. Phone/Fax

Practice location:
  • Phone: 817-372-0353
  • Fax: 817-585-4064
Mailing address:
  • Phone: 817-372-0353
  • Fax: 817-585-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LACHELLE GRACE GOODRICH
Title or Position: OWNER/CLINICIAN
Credential: LPC-S
Phone: 817-372-0353