{"npi":"1770510075","type":"NPI-2","status":"active","name":{"display":"Legacy Counseling Center INC","other":[],"organization_name":"LEGACY COUNSELING CENTER INC","authorised_official":"Melissa Grove"},"specialty":{"primary_taxonomy":"1041C0700X","primary_taxonomy_description":"Clinical Social Worker","slug":"clinical-social-worker","schema_org_specialty":null,"all":[{"code":"1041C0700X","description":"Clinical Social Worker","primary":true,"state":"TX","license":"S18803"}]},"addresses":[{"purpose":"LOCATION","street_1":"4054 MCKINNEY AVE STE 102","city":"DALLAS","state":"TX","postal_code":"752042050","country_code":"US","phone":"2145206308"},{"purpose":"MAILING","street_1":"4054 MCKINNEY AVE STE 102","city":"DALLAS","state":"TX","postal_code":"752042050","country_code":"US","phone":"2145206308"}],"license":{"state":"TX","number":"S18803"},"identifiers":[{"type_code":"01","label":"Other","value":"55GT","state":null,"issuer":"BCBS"},{"type_code":"05","label":"Medicaid","value":"079683102","state":"TX","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20040615000189","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"TX","pac_id":"7416931829"}]},"enumeration_date":"2006-06-26","last_updated":"2017-05-31","_meta":{"source":"NPPES","snapshot_date":"2017-05-31","doc_url":"https://findmynpi.com/api"}}