Provider Demographics
NPI:1104680271
Name:LEGACY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:LEGACY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TYPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, PMHNP-BC
Authorized Official - Phone:720-338-6870
Mailing Address - Street 1:10940 S PARKER RD # 179
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7440
Mailing Address - Country:US
Mailing Address - Phone:720-338-6870
Mailing Address - Fax:616-369-0917
Practice Address - Street 1:13575 E 104TH AVE UNIT 300
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-8401
Practice Address - Country:US
Practice Address - Phone:720-689-1165
Practice Address - Fax:616-369-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty