Provider Demographics
NPI: | 1881842953 |
---|---|
Name: | MCO LEGACY LLC |
Entity Type: | Organization |
Organization Name: | MCO LEGACY LLC |
Other - Org Name: | HEADSUP GUIDANCE AND WELLNESS CENTERS OF NEVADA |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CLINICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PATRICK |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | SCOTT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD LCSW DCSW FAPA |
Authorized Official - Phone: | 702-922-7015 |
Mailing Address - Street 1: | 2881 S VALLEY VIEW BLVD STE 1 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89102-0145 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-922-7015 |
Mailing Address - Fax: | 702-922-6600 |
Practice Address - Street 1: | 2881 S VALLEY VIEW BLVD STE 1 |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89102-0145 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-922-7015 |
Practice Address - Fax: | 702-922-6600 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-09-03 |
Last Update Date: | 2024-04-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |