Provider Demographics
NPI:1871489716
Name:J. BUBBA LEGG COUNSELING LLC
Entity type:Organization
Organization Name:J. BUBBA LEGG COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEGG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-989-9143
Mailing Address - Street 1:1549 N HEIGHTS DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1157
Mailing Address - Country:US
Mailing Address - Phone:208-989-9143
Mailing Address - Fax:541-443-2601
Practice Address - Street 1:1549 N HEIGHTS DR NW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1157
Practice Address - Country:US
Practice Address - Phone:208-989-9143
Practice Address - Fax:541-443-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty