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Organization
LEGACY COUNSELING CENTER INC
Active
Organization
LEGACY COUNSELING CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GROVE LPC, M.S. (EXECUTIVE DIRECTOR)
(214) 520-6308
Entity
Organization
Contact information
Practice address
4054 MCKINNEY AVE STE 102, DALLAS, TX 75204-2050
(214) 520-6308
Mailing address
4054 MCKINNEY AVE STE 102, DALLAS, TX 75204-2050
(214) 520-6308
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
S18803
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079683102
—
TX
01
—
55GT
BCBS
—
Enumeration date
06/26/2006
Last updated
05/31/2017
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