=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104742030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPACT COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2026
-----------------------------------------------------
Last Update Date | 06/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1370 NW 114TH ST STE 305
-----------------------------------------------------
City | CLIVE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50325-7012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-493-6019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1871 NW 155TH CT
-----------------------------------------------------
City | CLIVE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50325-7870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-493-6019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH THERAPIST
-----------------------------------------------------
Name | BROOKE SANDERS
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 515-493-6019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------