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General NPI Number Information
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NPI Number | 1104680271
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Entity Type | Organization
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Legal Business Name | LEGACY MENTAL HEALTH LLC
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Dates
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Enumeration Date | 02/09/2024
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 13575 E 104TH AVE UNIT 300
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City | COMMERCE CITY
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State | CO
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Zip | 80022-8401
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Country | US
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Telephone | 720-689-1165
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Fax | 616-369-0917
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Provider Business Mailing Address
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Address Line | 10940 S PARKER RD # 179
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City | PARKER
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State | CO
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Zip | 80134-7440
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Country | US
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Telephone | 720-338-6870
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Fax | 616-369-0917
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | TYPHANIE BEASLEY
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Credential | DNP, FNP-C, PMHNP-BC
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Telephone | 720-338-6870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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