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Organization
ICON LEGACY GROUP LLC
Active
Organization
ICON LEGACY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE WAGNER (CEO)
(214) 803-4512
Entity
Organization
Contact information
Practice address
802 SWITZER LN, CEDAR HILL, TX 75104-7254
(214) 803-4512
Mailing address
802 SWITZER LN, CEDAR HILL, TX 75104-7254
(214) 803-4512
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/26/2021
Last updated
03/26/2021
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