Healthcare Provider Details

I. General information

NPI: 1588501720
Provider Name (Legal Business Name): IMPETUS INTEGRATIVE COUNSELING & WELLNESS SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 SW 57TH ST
DAVIE FL
33314-7106
US

IV. Provider business mailing address

5510 SW 44TH TER
FORT LAUDERDALE FL
33314-6720
US

V. Phone/Fax

Practice location:
  • Phone: 954-326-2795
  • Fax:
Mailing address:
  • Phone: 954-326-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. TIFFANY EVE VASTARDIS
Title or Position: CEO
Credential: PHD, LHMC
Phone: 954-326-2795