Healthcare Provider Details

I. General information

NPI: 1346860608
Provider Name (Legal Business Name): IMPACT BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 WATERFORD WAY
AMBLER PA
19002-3156
US

IV. Provider business mailing address

1720 WATERFORD WAY
AMBLER PA
19002-3156
US

V. Phone/Fax

Practice location:
  • Phone: 215-350-7236
  • Fax: 272-400-2026
Mailing address:
  • Phone: 215-350-7236
  • Fax: 272-400-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHELSIE COLLIER
Title or Position: OWNER
Credential: BCBA
Phone: 215-350-7236