Organization
KA LEGACY INC
Active
Other names
Legacy Online Counseling and Consulting LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA GRISSOM-TATROE LPC (CEO)
(870) 919-6585
Entity
Organization
Contact information
Practice address
103 W FLEEMAN, MANILA, AR 72442
(870) 919-6585
Mailing address
103 W FLEEMAN, BOX 835, MANILA, AR 72442
(870) 919-6585
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
429713402
BCBS
AR
Enumeration date
11/02/2023
Last updated
11/02/2023
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