| Doctor Name: | MR. LARRY JACKSON LEGG |
| NPI Number: | 1366571499 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. |
| License Number: | 630 |
| Business Practice Address: | 315 Fairview Heights Rd Summersville, WV - 266511086 |
| Business Phone Number: | 3048832380 |
| Business Fax Number: | 3048832383 |
| Mailing Address: | Route 1, Box 125 E, MEADOW BRIDGE |
| State: | WV |
| Postal Code: | 259769409 |
| Phone Number: | 3043926835 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 12/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | 630 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |