Provider Demographics
NPI:1174229413
Name:LEGACY MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:LEGACY MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-863-9455
Mailing Address - Street 1:1 INDEPENDENCE PLZ STE 720
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2655
Mailing Address - Country:US
Mailing Address - Phone:205-924-3111
Mailing Address - Fax:
Practice Address - Street 1:1 INDEPENDENCE PLZ STE 720
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2655
Practice Address - Country:US
Practice Address - Phone:205-924-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1366091886Medicaid