Legacy'S Impact Intervention L.L.C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LEGACY'S IMPACT INTERVENTION L.L.C

Practice address

3606 Idaho Ave
Bartlesville, OK 74006-2420

Phone

(918) 766-6998

NPI assigned

Jan 27, 2020

Organization subpart

No

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

Authorized official

Name

Shonta Crowder, LCSW

Title

Director/Therapist

Phone

(918) 766-6998

Specialties & licenses 5

Addresses

Other names 1

• Legacy's Impact Intervention L.L.C Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1336770627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 IDAHO AVE",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062420",
            "telephone_number": "918-766-6998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3606 IDAHO AVE",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062420",
            "telephone_number": "918-766-6998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY'S IMPACT INTERVENTION L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-27",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "CROWDER",
        "authorized_official_first_name": "SHONTA",
        "authorized_official_title_or_position": "DIRECTOR/THERAPIST",
        "authorized_official_telephone_number": "918-766-6998",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "legacysimpact@gmail.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3606 Idaho Ave",
            "city": "Bartlesville",
            "state": "OK",
            "country_code": "US",
            "postal_code": "740062420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Legacy's Impact Intervention L.L.C",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carol Lee
• Cullen Lee
• Heidie Lee
• Stacy Lee, PH.D.
• Stephen William Lee
• Legatski and Associates
• Tamunosisi E Legg-Jack, M.D.
• William K. Lemay, D.C.
• Nicholas Michael Leppke, ATC
• Leslie a. Faulkner, O.D. PLLC

• Clinical Social Worker in Bartlesville, OK
• Providers in Bartlesville, OK by specialty
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; 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.