NPIMap

Organization Active NPI

The Legacy House PLLC

  • Multi-Specialty Clinic/Center
  • Panama City, FL
National Provider Identifier
1932734845
Registry record updated Aug 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
THE LEGACY HOUSE PLLC
Practice address
2615 W 23Rd St
Panama City, FL 32405-2339
Phone
(850) 331-0134
Fax
(850) 306-6721
NPI assigned
Mar 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2020

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

Authorized official

Name
Denise Folsom, MSNPI 1578946448
Title
LMHC
Phone
(850) 331-0134

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2615 W 23Rd St
Panama City, FL 32405-2339

Mailing address

2615 W 23Rd St
Panama City, FL 32405-2339
Phone (850) 331-0134

National Provider Directory

National Provider Directory

Locations

725 E 24th Plz
Panama City, FL 32405
Phone (850) 331-0134

2615 W 23rd St
Panama City, FL 32405
Phone (850) 331-0134

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596758400000",
    "number": "1932734845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 W 23RD ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324052339",
            "telephone_number": "850-331-0134",
            "fax_number": "850-306-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 W 23RD ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324052339",
            "telephone_number": "850-331-0134",
            "fax_number": "850-306-6721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LEGACY HOUSE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A",
        "authorized_official_last_name": "FOLSOM",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "LMHC",
        "authorized_official_telephone_number": "850-331-0134",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "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
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.