Provider Demographics
NPI:1366879488
Name:LEGACY FAMILY INTERVENTION SERVICES, INC.
Entity type:Organization
Organization Name:LEGACY FAMILY INTERVENTION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSHELL
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-237-1141
Mailing Address - Street 1:12525 E 27TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-8233
Mailing Address - Country:US
Mailing Address - Phone:918-619-6394
Mailing Address - Fax:918-639-6394
Practice Address - Street 1:12525 E 27TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-8233
Practice Address - Country:US
Practice Address - Phone:918-619-6394
Practice Address - Fax:918-639-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health