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1225851678 NPI number — IMPACT MENTAL HEALTH THERAPY LLC

NPI Number: 1225851678
Health Care Provider/Practitioner: IMPACT MENTAL HEALTH THERAPY LLC

Information about “1225851678” NPI (IMPACT MENTAL HEALTH THERAPY LLC) exists in 1225851678 in HTML format HTML  |  1225851678 in plain Text format TXT  |  1225851678 in PDF (Portable Document Format) PDF  |  1225851678 in an XML format XML  formats.

NPI Number : 1225851678 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225851678",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IMPACT MENTAL HEALTH THERAPY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7041 GARLAND ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LINCOLN",
    "MailingAddressStateName": "NE",
    "MailingAddressPostalCode": "68505-1445",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7041 GARLAND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LINCOLN",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68505-1445",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "402-326-8579",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/04/2024",
    "LastUpdateDate": "12/13/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BURT",
    "AuthorizedOfficialFirstName": "SYDNIE",
    "AuthorizedOfficialMiddleName": "FAITH",
    "AuthorizedOfficialTitle": "THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MSW, LMHP",
    "AuthorizedOfficialTelephoneNumber": "402-326-8579",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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