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General NPI Number Information
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NPI Number | 1124092911
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Entity Type | Organization
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Legal Business Name | LEGACY CLINICAL CONSULTANTS, LLC
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 3033 OGDEN AVE STE 200
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City | LISLE
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State | IL
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Zip | 60532-1976
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Country | US
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Telephone | 877-443-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 13300 S ROUTE 59 SUITE B-7
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City | PLAINFIELD
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State | IL
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Zip | 60585-9847
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Country | US
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Telephone | 815-577-3666
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Fax | 815-577-2785
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JEFFREY BRIAN VANMETER
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Credential | PSYD
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Telephone | 877-443-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.008075
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.006312
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License Number State | IL
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Taxonomy #12
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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