Organization Active NPI

Legacy Assessment Group, LLC

  • Psychologist
  • Dallas, TX
National Provider Identifier
1316211436
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
24635 Issued in TX
Legal business name
LEGACY ASSESSMENT GROUP, LLC
Practice address
1341 W Mockingbird LN Ste 760
Dallas, TX 75247-6913
Phone
(214) 760-1964
Fax
(214) 760-9505
NPI assigned
Mar 7, 2012
Last updated
Aug 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Mr. Michael Jafarzadeh, PSYDNPI 1922544113
Title
Owner
Phone
(214) 760-1964

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 24635 TX Primary

Addresses

Primary practice location

1341 W Mockingbird LN Ste 760
Dallas, TX 75247-6913

Mailing address

1341 W Mockingbird LN Ste 760
Dallas, TX 75247-6913
Phone (214) 760-1964

Other identifiers 1

IdentifierTypeStateIssuer
309543201MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160910000263 TX Part B Supplier - Clinic/Group Practice 1658667001 Receives reassigned benefits from 2 practitioners
Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

Locations

16415 Addison Rd
Ste 640
Addison, TX 75001
Phone (214) 760-1964

600 Six Flags Dr
Ste 400
Arlington, TX 76011
Phone (817) 385-0088

1341 W Mockingbird Ln
Ste 760
Dallas, TX 75247
Phone (214) 760-1964

1341 W Mockingbird Ln
Ste 760W
Dallas, TX 75247
Phone (214) 760-1964

1412 Main St
Ste 205
Dallas, TX 75202
Phone (214) 760-1964

1412 Main St
Ste 320
Dallas, TX 75202
Phone (214) 736-8816

100 E 15th St
Ste 310
Fort Worth, TX 76102
Phone (214) 760-1964

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1316211436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1341 W MOCKINGBIRD LN STE 760",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752476913",
            "telephone_number": "214-760-1964",
            "fax_number": "214-760-9505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 W MOCKINGBIRD LN STE 760",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752476913",
            "telephone_number": "214-760-1964",
            "fax_number": "214-760-9505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY ASSESSMENT GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "JAFARZADEH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-760-1964",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "24635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "309543201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.