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General NPI Number Information
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NPI Number | 1023483906
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Entity Type | Organization
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Legal Business Name | IMPACT BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 4500 S MONACO ST #1036
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City | DENVER
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State | CO
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Zip | 80237-3427
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Country | US
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Telephone | 517-303-1861
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 S MONACO ST #1036
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City | DENVER
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State | CO
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Zip | 80237-3427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA WESTERN
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Credential | MSW, BCBA
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Telephone | 517-303-1861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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