Provider Demographics
NPI:1548042997
Name:IMPACT COUNSELING AND CONSULTING LLC
Entity type:Organization
Organization Name:IMPACT COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:FAIRLINE
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-587-2378
Mailing Address - Street 1:PO BOX 2581
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34451-2581
Mailing Address - Country:US
Mailing Address - Phone:352-419-4856
Mailing Address - Fax:
Practice Address - Street 1:6563 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6003
Practice Address - Country:US
Practice Address - Phone:727-390-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health