MEDICARE: J. BUBBA LEGG COUNSELING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1871489716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. BUBBA LEGG COUNSELING LLC

Provider Business Mailing Address
First Line	:	1549 N HEIGHTS DR NW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1157
Country	:	US
Telephone Number	:	208-989-9143
Fax Number	:	541-443-2601

Provider Business Practice Location Address
First Line	:	1549 N HEIGHTS DR NW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1157
Country	:	US
Telephone Number	:	208-989-9143
Fax Number	:	541-443-2601

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MR. JEREMIAH S LEGG
Credential	:	LCSW
Telephone Number	:	208-989-9143

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	04/15/2026

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