Healthcare Provider Details

I. General information

NPI: 1417507443
Provider Name (Legal Business Name): LEGACY COUNSELING AND WORKFORCE CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD STE 111
LAS VEGAS NV
89146-1067
US

IV. Provider business mailing address

4170 S DECATUR BLVD STE D9
LAS VEGAS NV
89103-6815
US

V. Phone/Fax

Practice location:
  • Phone: 702-763-7443
  • Fax: 702-763-7443
Mailing address:
  • Phone: 702-763-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRIS ALDEN DOSS
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 702-763-7443