# LEGACY THERAPEUTIC SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154125755
- **Authorized official:** ROBERT CORNELIUS (CEO)
- **Authorized official phone:** (405) 822-8458

## Contact information

- **Practice address:** 310 12TH AVE NE, NORMAN, OK 73071-5238
- **Practice address phone:** (405) 822-8458
- **Mailing address:** PO BOX 278, BIXBY, OK 74008-0278
- **Mailing address phone:** (405) 822-8458

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/02/2025
- **Last updated:** 04/02/2025