NPI Code Detail JSON Logo

1396312658 NPI number — IMPACT COUNSELING SERVICES, INC.

NPI Number: 1396312658
Health Care Provider/Practitioner: IMPACT COUNSELING SERVICES, INC.

Information about “1396312658” NPI (IMPACT COUNSELING SERVICES, INC.) exists in 1396312658 in HTML format HTML  |  1396312658 in plain Text format TXT  |  1396312658 in PDF (Portable Document Format) PDF  |  1396312658 in an XML format XML  formats.

NPI Number : 1396312658 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396312658",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IMPACT COUNSELING SERVICES, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3613 WILLIAMS DR STE 302",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GEORGETOWN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78628-1369",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-713-9886",
    "MailingAddressFaxNumber": "737-277-5546",
    "FirstLinePracticeLocationAddress": "3613 WILLIAMS DR STE 302",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GEORGETOWN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78628-1369",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-713-9886",
    "PracticeLocationAddressFaxNumber": "737-277-5546",
    "EnumerationDate": "06/07/2021",
    "LastUpdateDate": "07/08/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GADISON",
    "AuthorizedOfficialFirstName": "CANDI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "512-713-9886",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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