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General NPI Number Information
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NPI Number | 1871489716
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Entity Type | Organization
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Legal Business Name | J. BUBBA LEGG COUNSELING LLC
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 1549 N HEIGHTS DR NW
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City | ALBANY
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State | OR
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Zip | 97321-1157
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Country | US
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Telephone | 208-989-9143
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Fax | 541-443-2601
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Provider Business Mailing Address
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Address Line | 1549 N HEIGHTS DR NW
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City | ALBANY
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State | OR
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Zip | 97321-1157
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Country | US
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Telephone | 208-989-9143
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Fax | 541-443-2601
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MR. JEREMIAH S LEGG
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Credential | LCSW
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Telephone | 208-989-9143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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