Legacy Wellness Services LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

LEGACY WELLNESS SERVICES LLC

Practice address

6068 US Hwy 98 West
Hattiesburg, MS 39402

Phone

(228) 231-0516

NPI assigned

Jul 15, 2021

Last updated

Jul 15, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicole Lewis, LCSW, LICSWNPI 1427557560

Title

Clinical Director

Phone

(228) 231-0516

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

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.

• Nicole Lewis

  • Social Worker
  • Gulfport, MS
  • NPI 1427557560
  NPD Authorized official

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1912579202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6068 US HWY 98 WEST",
            "address_2": "STE 1 BOX 304",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39402",
            "telephone_number": "228-231-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6068 US HWY 98 WEST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39402",
            "telephone_number": "228-231-0516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY WELLNESS SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "228-231-0516",
        "authorized_official_credential": "LCSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NONE",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.LegacyWellnessServices.com",
            "affiliation": "N",
            "address_1": "6068 US Hwy 98 West",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "39402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ramona Lisa Leech, MS
• Grif A Leek, MD
• Lisa L Leek, MD
• Deborah Lefler, LPN
• Legacy Family Care Clinic
• Joe N Leigh, M.D.
• Jennifer L Lemacks, PH.D., R.D.
• Gary L Lett, D.C.
• Adam Lewis
• Nancy Danielle Lewis, DPT

• Mental Health Counselor in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; 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.