Positive Impact Therapeutic Services

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

19337 Issued in TX

Legal business name

POSITIVE IMPACT THERAPEUTIC SERVICES

Practice address

12650 N Beach St Ste 114
Fort Worth, TX 76244-4245

Phone

(832) 338-4711

NPI assigned

Oct 1, 2013

Organization subpart

No

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

Authorized official

Name

Marnee Crutchfield

Title

Administrator

Phone

(832) 338-4711

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380585600000",
    "number": "1124455571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12650 N BEACH ST STE 114",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12650 N BEACH ST STE 114",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762444245",
            "telephone_number": "832-338-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POSITIVE IMPACT THERAPEUTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-01",
        "last_updated": "2013-10-01",
        "status": "A",
        "authorized_official_last_name": "CRUTCHFIELD",
        "authorized_official_first_name": "MARNEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "832-338-4711"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "19337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203432401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; 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.