MEDICARE: LEGENDARY COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center
3	1041C0700X	Clinical Social Worker
4	106H00000X	Marriage & Family Therapist
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1356953046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGENDARY COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	7925 S BROADWAY AVE STE 440
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-5297
Country	:	US
Telephone Number	:	903-705-6552
Fax Number	:	903-705-6532

Provider Business Practice Location Address
First Line	:	7925 S BROADWAY AVE STE 440
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-5297
Country	:	US
Telephone Number	:	903-705-6552
Fax Number	:	903-705-6532

Authorized Official
Title or Position	:	OWNER/PROFESSIONAL COUNSELOR
Name	:	ERIN CAMERON
Credential	:	LPC
Telephone Number	:	903-705-6337

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	04/13/2026

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