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General NPI Number Information
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NPI Number | 1407211535
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Entity Type | Organization
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Legal Business Name | MAJOR IMPACT, INC.
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 1960 VELASCO ST SUITE J-2
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City | FORT MYERS
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State | FL
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Zip | 33916-2761
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Country | US
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Telephone | 239-226-4357
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Fax | 239-226-4352
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Provider Business Mailing Address
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Address Line | 1960 VELASCO ST SUITE J-2
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City | FORT MYERS
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State | FL
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Zip | 33916-2761
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Country | US
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Telephone | 239-226-4357
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Fax | 239-226-4352
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. CLAYTON LAMBERT MAJOR SR.
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Credential | M.S.
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Telephone | 239-226-4357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2036AD2405-01
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License Number State | FL
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