| Legacy Health And Wellness, Llc | |
|
2921 N Tenaya Way Las Vegas NV 89128-0381 | |
| (702) 942-1774 | |
| Not Available |
| Full Name | Legacy Health And Wellness, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2921 N Tenaya Way, Las Vegas, Nevada |
| Authorized Official Name and Position | Abby Marie Grossa (CFO) |
| Authorized Official Contact | 7023388373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Health And Wellness, Llc 2921 N Tenaya Way Las Vegas NV 89128-1409 Ph: (702) 338-8373 | Legacy Health And Wellness, Llc 2921 N Tenaya Way Las Vegas NV 89128-0381 Ph: (702) 942-1774 |
| NPI Number | 1457600645 |
|---|---|
| Provider Enumeration Date | 09/03/2012 |
| Last Update Date | 01/04/2023 |
| Certification Date | 01/04/2023 |
| Medicare PECOS PAC ID | 9335363118 |
|---|---|
| Medicare Enrollment ID | O20140618000244 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457600645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | E0435602012-5 (Nevada) | Primary |
| Provider Name | Shelly Rienhardt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376973768 PECOS PAC ID: 0941556765 Enrollment ID: I20180710001932 |
| Provider Name | Vex'alia Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528436573 PECOS PAC ID: 4284974254 Enrollment ID: I20190329001003 |
| Provider Name | Brenna Elaine Benas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841636008 PECOS PAC ID: 4082042734 Enrollment ID: I20200312000942 |
| Provider Name | David J Ventrelle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639342140 PECOS PAC ID: 1850437369 Enrollment ID: I20220815000650 |
| Provider Name | Liam Alexander Paige |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083969885 PECOS PAC ID: 1052795846 Enrollment ID: I20220828000082 |
| Provider Name | Liane Etsuko Taylan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205109543 PECOS PAC ID: 4789053406 Enrollment ID: I20221219002415 |
| Provider Name | Wilda Castro |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1891231809 PECOS PAC ID: 5395197982 Enrollment ID: I20240118004641 |
| Provider Name | Melissa A Hildebrand |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1306252762 PECOS PAC ID: 0941652473 Enrollment ID: I20240119001649 |
| Provider Name | Mary Irene Wammack |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1861771180 PECOS PAC ID: 9931551314 Enrollment ID: I20240122002376 |
| Provider Name | Alicia Scott |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518197185 PECOS PAC ID: 6406208719 Enrollment ID: I20240122003912 |
| Provider Name | Jennalyn Eigner |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1396121257 PECOS PAC ID: 6709239635 Enrollment ID: I20240126004164 |
| Provider Name | Joseph Sleman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1104251099 PECOS PAC ID: 9739532318 Enrollment ID: I20240131000169 |
| Provider Name | Jonathan F Brown |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1235532953 PECOS PAC ID: 9931542099 Enrollment ID: I20240206003526 |
| Provider Name | Christi Delynn Passalacqua |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1164766101 PECOS PAC ID: 3274977384 Enrollment ID: I20240216001858 |
| Provider Name | Kimberly Wood |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447811120 PECOS PAC ID: 6507204591 Enrollment ID: I20240410001189 |
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