Organization
LEGACY BEHAVIORAL HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY JACKS PMHNP (OWNER)
(315) 547-0502
Entity
Organization
Contact information
Practice address
10463 PONDEROSA PINE AVE, WALDORF, MD 20603-5794
(315) 547-0502
Mailing address
10463 PONDEROSA PINE AVE, WALDORF, MD 20603-5794
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/26/2026
Last updated
05/26/2026
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