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General NPI Number Information
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NPI Number | 1336004746
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Entity Type | Organization
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Legal Business Name | NEW LEGACY BEHAVIORAL HEALTH LICENSED PROFESSIONAL CLINICAL COUNSELOR INC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 24904 LEAR LN
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5875
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Country | US
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Telephone | 661-742-4026
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Fax |
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Provider Business Mailing Address
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Address Line | 24904 LEAR LN
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5875
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Country | US
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Telephone | 661-742-4026
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JASMINE MIMS
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Credential | LPCC
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Telephone | 661-742-4026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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