Jonathan L. Leggett, PHD
Individual provider Active NPI Prescribing (Medical) Psychologist · Gallup, NM
NPI 1831497783 · NPPES record last updated Jun 27, 2023
Key facts
- NPI
- 1831497783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prescribing (Medical) Psychologist 103TP0016X
- License
- 1279 (NM)
- Practice address
- 303 S First St
Gallup, NM 87301-6211 - Phone
- (505) 397-7197
- NPI assigned
- Mar 2, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140127000879 | NM | Practitioner - Clinical Psychologist | 8527245349 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99045855A | IN | MD | Psychologist |
| 1279 | NM | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presbyterian Medical Services | Current |
Accepting new patients | |
| Presbyterian Medical Services | Current |
Accepting new patients | |
| Presbyterian Medical Services | Current | Accepting new patients | |
| Gallup Community Health | Psychologist | Current |
Accepting new patients |
Locations
2111 College Dr
Gallup, NM 87301
Phone (505) 397-5172
2022 E Aztec Ave
Gallup, NM 87301
Phone (505) 397-5172
1422 Paseo de Peralta
Santa Fe, NM 87501
Phone (505) 982-5565
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FBBICD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 99045855A | IN | |
| Counseling Psychologist | 103TC1900X | 1279 | NM | |
| Prescribing (Medical) Psychologist | 103TP0016X | 1279 | NM | Yes |
Addresses
Primary practice location
303 S First St
Gallup, NM 87301-6211
Mailing address
303 S First St
Gallup, NM 87301-6211
Phone (505) 397-7197
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201050210 | Medicaid | IN |
Other providers in Gallup, NM
- Megan Lee
- Marilyn Leekity
- Legacy Family Medicine LLC
- Lesley J Legah
- Joanna L Leggett
- Theodore L. Lemle
- Tracy Leonard
- Sarah Renae Leonetti
- Amanda Gayle Lesansee
- Dianne Elizabeth Lesansee
All providers in Gallup, NM · Prescribing (Medical) Psychologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.