NPIMap

Organization Active NPI

Legacy Counseling Center Inc

  • Clinical Social Worker
  • Dallas, TX
National Provider Identifier
1770510075
Registry record updated May 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
S18803 Issued in TX
Legal business name
LEGACY COUNSELING CENTER INC
Practice address
4054 McKinney Ave Ste 102
Dallas, TX 75204-2050
Phone
(214) 520-6308
NPI assigned
Jun 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2017

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

Authorized official

Name
Melissa Grove, LPC, M.S.NPI 1194733212
Title
Executive Director
Phone
(214) 520-6308

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
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X S18803 TX Primary

Addresses

Primary practice location

4054 McKinney Ave Ste 102
Dallas, TX 75204-2050

Mailing address

4054 McKinney Ave Ste 102
Dallas, TX 75204-2050
Phone (214) 520-6308

Other identifiers 2

IdentifierTypeStateIssuer
55GTOtherBCBS
079683102MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040615000189 TX Part B Supplier - Clinic/Group Practice 7416931829 Receives reassigned benefits from 2 practitioners
Practice locations: Dallas, TX

National Provider Directory

National Provider Directory

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496188800000",
    "number": "1770510075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4054 MCKINNEY AVE STE 102",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752042050",
            "telephone_number": "214-520-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4054 MCKINNEY AVE STE 102",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752042050",
            "telephone_number": "214-520-6308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY COUNSELING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2017-05-31",
        "status": "A",
        "authorized_official_last_name": "GROVE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "214-520-6308",
        "authorized_official_credential": "LPC, M.S."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "S18803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "55GT",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079683102",
            "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 May 31, 2017; 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.