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LEGACY BEHAVIORAL HEALTH SERVICES LLC
NPI 1376474783
Nurse Practitioner - Psychiatric/Mental Health in Waldorf, MD

Active since May 26, 2026
10463 PONDEROSA PINE AVE, WALDORF, MD 20603(315) 547-0502 Get Directions Write a Review

NPPES record last updated: May 26, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Legacy Behavioral Health Services Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LEGACY BEHAVIORAL HEALTH SERVICES LLC (NPI 1376474783) is a healthcare organization registered as a psychiatric/mental health in Waldorf, Maryland and active in the NPI registry since May 2026. The organization lists Becky Jacks, Owner, as its authorized official.

NPPES Registry Identity

NPI1376474783
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameLEGACY BEHAVIORAL HEALTH SERVICES LLC
Location Address10463 PONDEROSA PINE AVEWaldorf, MD 20603-5794
Mailing Address10463 Ponderosa Pine AveWaldorf, MD 20603-5794
Phone(315) 547-0502
Organization SubpartNo
Authorized OfficialBecky JacksOwner · (315) 547-0502
Enumeration DateMay 26, 2026
NPPES CertifiedMay 26, 2026
✔ NPI 1376474783 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
10463 PONDEROSA PINE AVE, Waldorf, MD 20603
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Legacy Behavioral Health Services LLC's NPI number?

The NPI number for Legacy Behavioral Health Services LLC is 1376474783. It was assigned to this organization in the NPPES registry on May 26, 2026.

Where is Legacy Behavioral Health Services LLC located?

Legacy Behavioral Health Services LLC is located at 10463 Ponderosa Pine Ave, Waldorf, MD 20603. The listed phone number is (315) 547-0502.

What is Legacy Behavioral Health Services LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Legacy Behavioral Health Services LLC was last updated on May 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.