MEDICARE: LEGACY COMMUNITY BEHAVIORAL HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP1600X	Pastoral Counselor
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1659051142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY COMMUNITY BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	500 REED AVE
Second Line	:
City	:	EUNICE
State	:	LA
Zip	:	70535-3238
Country	:	US
Telephone Number	:	318-730-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 HOUSTON ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-4332
Country	:	US
Telephone Number	:	318-427-7748
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/FOUNDER
Name	:	DR. VICTOR WHITE SR.
Credential	:	EDD, MA, LPC, LAC,
Telephone Number	:	318-730-9757

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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