Legacy Behavioral Health & Wellness

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

LEGACY BEHAVIORAL HEALTH & WELLNESS

Practice address

8105 Rasor Blvd Ste 248
Plano, TX 75024-0341

Phone

(469) 461-1557

NPI assigned

Jul 19, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mayra C Koedam, FNP-C, PMHNP-BCNPI 1346695178

Title

Nurse Practitioner

Phone

(972) 900-8640

Specialties & licenses 2

Addresses

Electronic endpoints 1

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Legacy Behavioral Health & Wellness

  • Primary Care Nurse Practitioner
  • Plano, TX
  • NPI 1528733359
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mayra Cruz Koedam, FNP-C

  • Family Nurse Practitioner
  • Dallas, TX
  • NPI 1346695178
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626652800000",
    "number": "1144893173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 LEGACY DR APT 28206",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750346643",
            "telephone_number": "972-900-8640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8105 RASOR BLVD STE 248",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750240341",
            "telephone_number": "469-461-1557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY BEHAVIORAL HEALTH & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-19",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A",
        "authorized_official_last_name": "KOEDAM",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "972-900-8640",
        "authorized_official_credential": "FNP-C, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "nppes.cms.hhs.gov",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8105 Rasor Blvd Ste 248",
            "city": "Plano",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750240341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Yu Lin Lee, MD
• Elizaveta Leeper, LPC, LCDC
• Jana McAlexander Leeper, M.ED., LPC ASSOCIATE
• Joel Norman Leffler, M.D.
• Tennille L Leftwich, PA-C
• Legacy Behavioral Health & Wellness
• Legacy Care Concierge LLC
• Legacy Eye Pieces PC
• Legacy Family Counseling and Consulting
• Legacy Heart Center

• Psychiatric/Mental Health Nurse Practitioner in Plano, TX
• Providers in Plano, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.