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General NPI Number Information
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NPI Number | 1730077082
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Entity Type | Organization
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Legal Business Name | LEGACY BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 100 W BIG BEAVER RD STE 200
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City | TROY
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State | MI
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Zip | 48084-5283
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Country | US
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Telephone | 810-513-9611
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W BIG BEAVER RD STE 200
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City | TROY
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State | MI
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Zip | 48084-5283
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Country | US
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Telephone | 734-274-9404
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Fax | 734-822-0075
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JASMINE COFIELD
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Credential | PA-C
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Telephone | 810-513-9611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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