Legacy Psychological Services, PLLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

LEGACY PSYCHOLOGICAL SERVICES, PLLC

Practice address

1919 Oakwell Farms Pkwy Ste 138
San Antonio, TX 78218-1725

Phone

(210) 819-5941

NPI assigned

Sep 9, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lara Conrad-Shearburn, PHDNPI 1972905750

Title

Licensed Psychologist

Phone

(210) 819-5941

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lara Conrad-Shearburn, PHD

  • Psychologist
  • San Antonio, TX
  • NPI 1972905750
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1205505674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 OAKWELL FARMS PKWY STE 138",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782181725",
            "telephone_number": "210-819-5941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 OAKWELL FARMS PKWY STE 138",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782181725",
            "telephone_number": "210-819-5941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PSYCHOLOGICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "CONRAD-SHEARBURN",
        "authorized_official_first_name": "LARA",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "210-819-5941",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Leftin
• Justine Marie Leftwich, OTR/L
• Legacy Dental Sa PC
• Legacy Healthcare Services Inc (Legacy Rehabilitation Services, Inc.)
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• Legacy Trails Medical Center
• Legacy Valley Counseling
• Mario Noli Guda Legarde III
• Gary Laurent Legault, M.D.
• Legend Oaks - Sonterra, LLC (Sonterra Health Center)

• Adolescent and Children Mental Health Clinic/Center in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Adolescent and Children Mental Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.