Organization
LEGACY BEHAVIORAL HEALTH & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAYRA C KOEDAM FNP-C, PMHNP-BC (NURSE PRACTITIONER)
(972) 900-8640
Entity
Organization
Contact information
Practice address
8105 RASOR BLVD STE 248, PLANO, TX 75024-0341
(469) 461-1557
Mailing address
3700 LEGACY DR APT 28206, FRISCO, TX 75034-6643
(972) 900-8640
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/19/2021
Last updated
07/19/2021
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