| Legacy's Impact Intervention L.l.c | |
|
3606 Idaho Ave Bartlesville OK 74006-2420 | |
| (918) 766-6998 | |
| Not Available |
| Full Name | Legacy's Impact Intervention L.l.c |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3606 Idaho Ave, Bartlesville, Oklahoma |
| Authorized Official Name and Position | Shonta Crowder (DIRECTOR/THERAPIST) |
| Authorized Official Contact | 9187666998 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy's Impact Intervention L.l.c 3606 Idaho Ave Bartlesville OK 74006-2420 Ph: (918) 766-6998 | Legacy's Impact Intervention L.l.c 3606 Idaho Ave Bartlesville OK 74006-2420 Ph: (918) 766-6998 |
| NPI Number | 1336770627 |
|---|---|
| Provider Enumeration Date | 01/27/2020 |
| Last Update Date | 01/27/2020 |
| Certification Date | 01/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336770627 | NPI | - | NPPES |
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