Legacy Behavioral Health Services LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

LEGACY BEHAVIORAL HEALTH SERVICES LLC

Practice address

10463 Ponderosa Pine Ave
Waldorf, MD 20603-5794

Phone

(315) 547-0502

NPI assigned

May 26, 2026

Organization subpart

No

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

Authorized official

Name

Becky Jacks, PMHNPNPI 1245911767

Title

Owner

Phone

(315) 547-0502

Specialties & licenses 1

Addresses

Practitioners 1

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

• Becky A Jacks

  • Psychiatric/Mental Health Nurse Practitioner
  • Waldorf, MD
  • NPI 1245911767
  NPD Authorized official

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

{
    "created_epoch": "1779753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1376474783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10463 PONDEROSA PINE AVE",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206035794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10463 PONDEROSA PINE AVE",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206035794",
            "telephone_number": "315-547-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-26",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "JACKS",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-547-0502",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Lee
• Axel Lee
• Leteace Lee, IBCLC, RN
• Nicole Janee' Lee, M.D.
• Youjin Lee, PT
• Legacy II Incorporated
• Monica Renee Leid, PA-C
• Derick Leku
• Lauren Faith Lemons, PA
• Lenstek LTD. T/a Pearle Vision

• Psychiatric/Mental Health Nurse Practitioner in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; 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.