Provider Demographics
| NPI: | 1881842953 |
|---|---|
| Name: | MCO LEGACY LLC |
| Entity type: | Organization |
| Organization Name: | MCO LEGACY LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CLINICAL DIRECTOR |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | PATRICK |
| Authorized Official - Middle Name: | R |
| Authorized Official - Last Name: | SCOTT |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD LCSW DCSW FAPA |
| Authorized Official - Phone: | 702-922-7015 |
| Mailing Address - Street 1: | 2881 S VALLEY VIEW BLVD STE 1 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LAS VEGAS |
| Mailing Address - State: | NV |
| Mailing Address - Zip Code: | 89102-0145 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 702-922-7015 |
| Mailing Address - Fax: | 702-922-6600 |
| Practice Address - Street 1: | 2881 S VALLEY VIEW BLVD STE 1 |
| Practice Address - Street 2: | |
| Practice Address - City: | LAS VEGAS |
| Practice Address - State: | NV |
| Practice Address - Zip Code: | 89102-0145 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 702-922-7015 |
| Practice Address - Fax: | 702-922-6600 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2008-09-03 |
| Last Update Date: | 2024-04-01 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
| No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
