Provider Demographics
NPI:1164131322
Name:LEGACY BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:LEGACY BEHAVIORAL SERVICES, LLC
Other - Org Name:LEGACY BEHAVIORAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:LEXI
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:970-270-7204
Mailing Address - Street 1:1312 17TH ST # 1311
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1508
Mailing Address - Country:US
Mailing Address - Phone:970-270-7204
Mailing Address - Fax:
Practice Address - Street 1:2591 LEGACY WAY
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-1789
Practice Address - Country:US
Practice Address - Phone:970-549-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty