Provider Demographics
NPI:1548828767
Name:LEGG, TERRY JOHN (LPC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:JOHN
Last Name:LEGG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SPRUCE CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-8988
Mailing Address - Country:US
Mailing Address - Phone:208-989-7279
Mailing Address - Fax:
Practice Address - Street 1:16 12TH AVE S STE 110
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3962
Practice Address - Country:US
Practice Address - Phone:208-515-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7326101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty