MEDICARE: IMPACT COUNSELING AND WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker
3	251B00000X	Case Management Agency
4	261QM1300X	Multi-Specialty Clinic/Center
5	324500000X	Substance Abuse Rehabilitation Facility
6	101YP2500X	Professional Counselor	17269	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851749220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACT COUNSELING AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	3531 DE SOTO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-3719
Country	:	US
Telephone Number	:	713-294-2439
Fax Number	:

Provider Business Practice Location Address
First Line	:	3531 DE SOTO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77091-3719
Country	:	US
Telephone Number	:	713-294-2439
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. HOLLY LEE-MCCAIN
Credential	:	LPC-S
Telephone Number	:	713-294-2439

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	08/27/2025

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