Healthcare Provider Details

I. General information

NPI: 1104742030
Provider Name (Legal Business Name): EMPACT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 NW 114TH ST STE 305
CLIVE IA
50325-7012
US

IV. Provider business mailing address

1871 NW 155TH CT
CLIVE IA
50325-7870
US

V. Phone/Fax

Practice location:
  • Phone: 515-493-6019
  • Fax:
Mailing address:
  • Phone: 515-493-6019
  • 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: BROOKE SANDERS
Title or Position: MENTAL HEALTH THERAPIST
Credential: LMHC
Phone: 515-493-6019