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General NPI Number Information
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NPI Number | 1184168841
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Entity Type | Organization
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Legal Business Name | IMPACT COUNSELING
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 100 CELIA ST SW
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City | WYOMING
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State | MI
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Zip | 49548-1121
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Country | US
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Telephone | 313-404-5810
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CELIA ST SW
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City | WYOMING
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State | MI
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Zip | 49548-1121
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Country | US
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Telephone | 313-404-5810
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KARL D BUTLER SR.
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Credential | LLMSW
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Telephone | 313-404-5810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801097359
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License Number State | MI
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