Provider Demographics
NPI:1053887273
Name:LEGGETT, DEBRA GAIL (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:GAIL
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 59TH STREET WEST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-729-6600
Mailing Address - Fax:
Practice Address - Street 1:1450 59TH STREET WEST
Practice Address - Street 2:UNIT 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-729-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health