Provider Demographics
NPI:1609697754
Name:LEGGETT, STACY LYNN (PLPC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SKYLANE DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4242
Mailing Address - Country:US
Mailing Address - Phone:662-889-3441
Mailing Address - Fax:
Practice Address - Street 1:599 HIGHLAND COLONY PKWY STE 110
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-6075
Practice Address - Country:US
Practice Address - Phone:601-202-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional