MEDICARE: IMPACT HEALTHCARE AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87-8562783	OTHER	TX	BLUE CROSS BLUE SHIELD
2	878562783	OTHER	TX	AMERIGROUP

General Provider Information

NPI Number	:	1073257325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACT HEALTHCARE AND WELLNESS

Provider Business Mailing Address
First Line	:	7118 CHAMPIONS CENTRE ESTATE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-2347
Country	:	US
Telephone Number	:	832-814-6167
Fax Number	:

Provider Business Practice Location Address
First Line	:	7118 CHAMPIONS CENTRE ESTATE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-2347
Country	:	US
Telephone Number	:	832-432-0303
Fax Number	:

Authorized Official
Title or Position	:	LICENSE PROFESSIONAL COUNSELOR
Name	:	MRS. DANIELLE S. PATTON
Credential	:	LPC, NCC
Telephone Number	:	832-432-0303

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	12/13/2024

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Directions to “IMPACT HEALTHCARE AND WELLNESS ” Practice Location

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