Mikala a Legako PSYD Psych SVC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002428 Issued in GA

Legal business name

MIKALA A LEGAKO PSYD PSYCH SVC

Practice address

83 Bailey Dr
Newnan, GA 30263-2913

Phone

(678) 314-7469

NPI assigned

Mar 4, 2008

Organization subpart

No

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

Authorized official

Name

Mikala Anne Legako, PSYDNPI 1336261718

Title

Psychologist/Owner

Phone

(678) 314-7469

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Mikala Anne Legako, PSYD

  • Clinical Psychologist
  • Newnan, GA
  • NPI 1336261718
  NPD Authorized official

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596326400000",
    "number": "1952571101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 BAILEY DR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302632913",
            "telephone_number": "678-314-7469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 BAILEY DR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302632913",
            "telephone_number": "678-314-7469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKALA A LEGAKO PSYD PSYCH SVC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-04",
        "last_updated": "2020-08-02",
        "certification_date": "2020-08-02",
        "status": "A",
        "authorized_official_last_name": "LEGAKO",
        "authorized_official_first_name": "MIKALA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "678-314-7469",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "002428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGY LICENSE",
            "identifier": "002428",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000895617B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Newnan, GA
• Providers in Newnan, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.