Ka Legacy INC

NPI #1174396980 in Manila, Arkansas

Provider Information

NPI Number: 1174396980
Entity Type: Organization
Organization Name: Ka Legacy INC
Primary Specialty: Counselor - Professional
Enumeration Date: Nov 2, 2023
Last Updated: Nov 2, 2023

Practice Location

Address: 103 W FLEEMAN
City: Manila
State: Arkansas
ZIP Code: 72442
Phone: (870) 919-6585

Authorized Official

Name: TONYA GRISSOM-TATROE, LPC
Title: CEO
Phone: (870) 919-6585

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community/Behavioral Health	251S00000X
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X
Counselor - Professional — Professional	101YP2500X	Primary

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