Provider Demographics
NPI:1962771329
Name:THE LEGACY INSTITUTE
Entity type:Organization
Organization Name:THE LEGACY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:623-398-4814
Mailing Address - Street 1:8190 W DEER VALLEY RD
Mailing Address - Street 2:#297
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2126
Mailing Address - Country:US
Mailing Address - Phone:623-398-4814
Mailing Address - Fax:623-234-3751
Practice Address - Street 1:8190 W DEER VALLEY RD
Practice Address - Street 2:#297
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2126
Practice Address - Country:US
Practice Address - Phone:623-398-4814
Practice Address - Fax:623-234-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3984103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty