# ICON LEGACY GROUP LLC

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

## Provider details

- **NPI number:** 1558948364
- **Authorized official:** MICHELLE WAGNER (CEO)
- **Authorized official phone:** (214) 803-4512

## Contact information

- **Practice address:** 802 SWITZER LN, CEDAR HILL, TX 75104-7254
- **Practice address phone:** (214) 803-4512
- **Mailing address:** 802 SWITZER LN, CEDAR HILL, TX 75104-7254
- **Mailing address phone:** (214) 803-4512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 03/26/2021
- **Last updated:** 03/26/2021