Provider Demographics
NPI:1548666985
Name:LEGACY COUNSELING SERVICES, INC
Entity type:Organization
Organization Name:LEGACY COUNSELING SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:651-497-1021
Mailing Address - Street 1:900 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-4412
Mailing Address - Country:US
Mailing Address - Phone:320-679-2438
Mailing Address - Fax:320-679-6906
Practice Address - Street 1:900 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-4412
Practice Address - Country:US
Practice Address - Phone:320-679-2438
Practice Address - Fax:320-679-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2524251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health