Provider Demographics
NPI:1851823686
Name:DECIDE YOUR LEGACY, LLC
Entity type:Organization
Organization Name:DECIDE YOUR LEGACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:316-361-6850
Mailing Address - Street 1:544 S RIDGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2234
Mailing Address - Country:US
Mailing Address - Phone:316-361-6850
Mailing Address - Fax:
Practice Address - Street 1:544 S RIDGE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2234
Practice Address - Country:US
Practice Address - Phone:316-361-6850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health