NPIMap

Organization Active NPI

Impact Behavioral Health and Recovery Care Corp

  • Clinical Social Worker
  • Fresno, CA
National Provider Identifier
1043890122
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
IMPACT BEHAVIORAL HEALTH AND RECOVERY CARE CORP
Practice address
1616 W Shaw Ave Ste B2
Fresno, CA 93711-3513
Phone
(559) 293-3174
Fax
(559) 570-0194
NPI assigned
Apr 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joshua McWealthNPI 1659763142
Title
Ceo
Phone
(559) 458-3947

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Licensed Psychiatric TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 167G00000X

Addresses

Primary practice location

1616 W Shaw Ave Ste B2
Fresno, CA 93711-3513

Mailing address

1616 W Shaw Ave Ste B4
Fresno, CA 93711-3513

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Therap Direct

National Provider Directory

National Provider Directory

Locations

1616 W Shaw Ave
Ste B4
Fresno, CA 93711
Phone (559) 289-6853

1616 W Shaw Ave
Ste B2
Fresno, CA 93711
Phone (559) 284-8669

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1043890122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 W SHAW AVE STE B4",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113513",
            "fax_number": "559-570-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 W SHAW AVE STE B2",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113513",
            "telephone_number": "559-293-3174",
            "fax_number": "559-570-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT BEHAVIORAL HEALTH AND RECOVERY CARE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-12",
        "last_updated": "2021-04-12",
        "certification_date": "2020-10-26",
        "status": "A",
        "authorized_official_last_name": "MCWEALTH",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-458-3947"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "167G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Psychiatric Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Therap",
            "affiliation": "N",
            "endpointDescription": "secure portal for client documentstion",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1616 W Shaw Ave Ste B4",
            "city": "Fresno",
            "state": "CA",
            "country_code": "US",
            "postal_code": "937113513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.