Organization
LEGACY'S IMPACT INTERVENTION L.L.C
Active
Other names
Legacy's Impact Intervention L.L.C
Organization subpart
No
Provider details
NPI number
Authorized official
SHONTA CROWDER LCSW (DIRECTOR/THERAPIST)
(918) 766-6998
Entity
Organization
Contact information
Practice address
3606 IDAHO AVE, BARTLESVILLE, OK 74006-2420
(918) 766-6998
Mailing address
3606 IDAHO AVE, BARTLESVILLE, OK 74006-2420
(918) 766-6998
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/27/2020
Last updated
01/27/2020
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