Active NPI
Larry Jackson Legg, M.A.
- Clinical Psychologist
- Summersville, WV
National Provider Identifier
1366571499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 630
- Practice address
- 702 Professional Park Dr
Ste 106
Summersville, WV 26651-2033 - Phone
- (304) 883-2380
- Fax
- (304) 883-2383
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 630 | WV | Primary |
| Counseling Psychologist | 103TC1900X | 630 | WV | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 630 | WV | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 630 | WV |
Addresses
Primary practice location
702 Professional Park Dr
Ste 106
Summersville, WV 26651-2033
Mailing address
3883 Farmdale Rd
Meadow Bridge, WV 25976-7035
Phone (304) 661-2742
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485475200000",
"number": "1366571499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3883 FARMDALE RD",
"city": "MEADOW BRIDGE",
"state": "WV",
"postal_code": "259767035",
"telephone_number": "304-661-2742",
"fax_number": "304-392-6835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "702 PROFESSIONAL PARK DR",
"address_2": "STE 106",
"city": "SUMMERSVILLE",
"state": "WV",
"postal_code": "266512033",
"telephone_number": "304-883-2380",
"fax_number": "304-883-2383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEGG",
"first_name": "LARRY",
"middle_name": "JACKSON",
"name_prefix": "Mr.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2017-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WV",
"license": "630",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "WV",
"license": "630",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "WV",
"license": "630",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "WV",
"license": "630",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summersville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.