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NPI Code Detail

MEDICARE: IMPACT THERAPY, LLC

MEDICARE: IMPACT THERAPY, 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
1101YA0400XAddiction (Substance Use Disorder) Counselor933549OH

General Provider Information

NPI Number : 1881025641
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMPACT THERAPY, LLC
Provider Business Mailing Address
First Line : 3450 W CENTRAL AVE STE 354
Second Line :
City : TOLEDO
State : OH
Zip : 43606-1418
Country : US
Telephone Number : 567-288-6769
Fax Number :
Provider Business Practice Location Address
First Line : 3450 W CENTRAL AVE STE 354
Second Line :
City : TOLEDO
State : OH
Zip : 43606-1418
Country : US
Telephone Number : 567-288-6769
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. LAMARR J NORWOOD
Credential : LICDC-CS
Telephone Number : 567-288-6769
Provider Enumeration Date : 12/04/2013
Last Update Date : 01/09/2020

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Directions to “IMPACT THERAPY, LLC ” Practice Location

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