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General NPI Number Information
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NPI Number | 1902270267
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Entity Type | Organization
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Legal Business Name | LEGACY FAMILY SERVICES INC.
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 11901 N MACARTHUR BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-1806
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Country | US
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Telephone | 405-202-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 11901 N MACARTHUR BLVD SUITE C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-1806
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Country | US
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Telephone | 405-202-1027
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | ASHLEY BRYANT
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Credential | MS, LPC
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Telephone | 405-202-1027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5636
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License Number State | OK
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