LEGACY CLINICAL CONSULTANTS LLC NPI 1124092911

NPI Information

NPI: 1124092911
Provider Name: LEGACY CLINICAL CONSULTANTS, LLC
Classification: Clinical Neuropsychologist - 103G00000X
Entity Type: Organization
Address:
3033 OGDEN AVE STE 200
LISLE, IL
ZIP 60532
Phone: (877) 443-7030
Get Directions

LEGACY CLINICAL CONSULTANTS, LLC is a clinical neuropsychologist in Lisle, IL. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. LEGACY CLINICAL CONSULTANTS, LLC NPI is 1124092911. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

3033 OGDEN AVE STE 200
LISLE, IL
ZIP 60532-976
Phone: (877) 443-7030

The provider's authorized official is Jeffrey Brian Vanmeter .
The authorized official title is Executive Director and has the following contact phone number (877) 443-7030.

The enumeration date for this NPI number is 2/16/2006 and was last updated on 4/5/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101Y00000X	Counselor				No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)			No
3	101YM0800X	Counselor	Mental Health			No
4	101YP2500X	Counselor	Professional			No
5	103G00000X	Clinical Neuropsychologist				Yes
6	103T00000X	Psychologist				No
7	103TA0700X	Psychologist	Adult Development & Aging			No
8	103TB0200X	Psychologist	Cognitive & Behavioral			No
9	103TC0700X	Psychologist	Clinical	071.006312	ILLINOIS	No
10	103TC2200X	Psychologist	Clinical Child & Adolescent			No
11	103TF0000X	Psychologist	Family			No
12	104100000X	Social Worker				No
13	1041C0700X	Social Worker	Clinical	149.008075	ILLINOIS	No
14	106H00000X	Marriage & Family Therapist				No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	9932120	OTHER	ILLINOIS	BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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