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General NPI Number Information
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NPI Number | 1225325251
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Entity Type | Organization
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Legal Business Name | LEGACY THERAPEUTIC CONSULTING, LLC
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 2121 S BLACKHAWK ST SUITE 210
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City | AURORA
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State | CO
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Zip | 80014-1487
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Country | US
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Telephone | 303-917-4145
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 S BLACKHAWK ST SUITE 210
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City | AURORA
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State | CO
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Zip | 80014-1487
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Country | US
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Telephone | 303-917-4145
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY J. SAMS
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Credential | MSW, LCSW
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Telephone | 303-917-4145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1328
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License Number State | CO
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