Provider Demographics
NPI:1306280888
Name:LEGGETT, PENNIE (MA, LAMFT)
Entity type:Individual
Prefix:MS
First Name:PENNIE
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12302 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-9734
Mailing Address - Country:US
Mailing Address - Phone:928-669-3256
Mailing Address - Fax:928-669-3252
Practice Address - Street 1:12033 AGENCY RD
Practice Address - Street 2:730
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-7718
Practice Address - Country:US
Practice Address - Phone:928-669-3256
Practice Address - Fax:928-669-3252
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-10311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist