Provider Demographics
NPI:1104140854
Name:LEGENDRE, STEVEN L (MA,,MPA,LPC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:LEGENDRE
Suffix:
Gender:M
Credentials:MA,,MPA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 N DESERT AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1957
Mailing Address - Country:US
Mailing Address - Phone:520-730-5843
Mailing Address - Fax:520-326-2919
Practice Address - Street 1:2767 N DESERT AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1957
Practice Address - Country:US
Practice Address - Phone:520-730-5843
Practice Address - Fax:520-326-2919
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0829101YP2500X
AZLMFT-0325106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional