C.T. Deep Impact LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

C.T. DEEP IMPACT LLC

Practice address

3100 S W S Young Dr # 10333
Killeen, TX 76542-2001

Phone

(210) 343-5107

NPI assigned

Sep 29, 2023

Organization subpart

No

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

Authorized official

Name

Emmanuel Tamarez, LPC

Title

Owner

Phone

(210) 343-5107

Specialties & licenses 1

Addresses

Other names 1

• CenTex Therapies Doing business as

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

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1093595845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 S W S YOUNG DR # 10333",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765422001",
            "telephone_number": "210-343-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 S W S YOUNG DR # 10333",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765422001",
            "telephone_number": "210-343-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C.T. DEEP IMPACT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-29",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "TAMAREZ",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-343-5107",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenTex Therapies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Counselor in Killeen, TX
• Providers in Killeen, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.