BLESSED LEGACY LLC NPI 1073193991

NPI Information

NPI: 1073193991
Provider Name: BLESSED LEGACY LLC
Classification: Clinic/Center - 261QM0855X
Specialization: Adolescent and Children Mental Health
Entity Type: Organization
Doing Business As: LIFE SKILLS ACADEMY
Address: 5602 GATEWAY DR
TAMPA, FL
ZIP 33615
Phone: (954) 638-3770

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NPI Details

BLESSED LEGACY LLC is an adolescent and children mental health clinic center in Tampa, FL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. BLESSED LEGACY LLC NPI is 1073193991. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Life Skills Academy.

The provider's business location address is:

5602 GATEWAY DR
TAMPA, FL
ZIP 33615-123
Phone: (954) 638-3770

The provider's authorized official is Yadira Suarez-pita .
The authorized official title is Owner and has the following contact phone number (954) 638-3770.

The enumeration date for this NPI number is 4/13/2021 and was last updated on 11/10/2024.

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	103K00000X	Behavior Analyst				No
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health			Yes

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	15908	MEDICAID	FLORIDA
2	106091700	MEDICAID	FLORIDA

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: 3/30/2025

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