Provider Demographics
NPI:1619734563
Name:LEGARD, ALLY (MCOUN)
Entity type:Individual
Prefix:
First Name:ALLY
Middle Name:
Last Name:LEGARD
Suffix:
Gender:F
Credentials:MCOUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 MATTOX RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7735
Mailing Address - Country:US
Mailing Address - Phone:971-267-0470
Mailing Address - Fax:
Practice Address - Street 1:4050 MATTOX RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7735
Practice Address - Country:US
Practice Address - Phone:971-267-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health