Provider Demographics
NPI:1114891389
Name:LEGACY MEDICAL SOL
Entity type:Organization
Organization Name:LEGACY MEDICAL SOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-505-0507
Mailing Address - Street 1:8615 DEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-4645
Mailing Address - Country:US
Mailing Address - Phone:310-505-0507
Mailing Address - Fax:
Practice Address - Street 1:17101 W GRAND PKWY S STE 103
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4985
Practice Address - Country:US
Practice Address - Phone:310-505-0507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty