NPIMap

Organization Active NPI

United Impact, LLC

  • Health Psychologist
  • Tallahassee, FL
National Provider Identifier
1114543568
Registry record updated Jun 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health PsychologistTaxonomy code 103TH0004X
Legal business name
UNITED IMPACT, LLC
Practice address
404 El Destinado Dr
Tallahassee, FL 32312-1607
Phone
(850) 510-0915
NPI assigned
Jun 22, 2020
Last updated
Jun 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2020

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

Authorized official

Name
Mrs. Philander Carol McCray-Head
Title
Part Owner
Phone
(850) 510-0915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Psychologist 103TH0004X NU Primary

Addresses

Primary practice location

404 El Destinado Dr
Tallahassee, FL 32312-1607

Mailing address

PO Box 1225
Tallahassee, FL 32302-1225
Phone (850) 510-0915

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592784000000",
    "number": "1114543568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1225",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323021225",
            "telephone_number": "850-510-0915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 EL DESTINADO DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323121607",
            "telephone_number": "850-510-0915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED IMPACT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A",
        "authorized_official_last_name": "MCCRAY-HEAD",
        "authorized_official_first_name": "PHILANDER",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "850-510-0915",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; 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.