NPIMap

Organization Active NPI

Impact Behavior Supports, Inc

  • Community/Behavioral Health Agency
  • Leesburg, FL
National Provider Identifier
1144844119
Registry record updated Jun 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
IMPACT BEHAVIOR SUPPORTS, INC
Practice address
1016 E North Blvd
Leesburg, FL 34748-5348
Phone
(352) 874-2986
NPI assigned
Jun 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2020

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

Authorized official

Name
Miss Jocelyn Mitchell, BCBANPI 1801395504
Title
President
Phone
(352) 874-2986

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1016 E North Blvd
Leesburg, FL 34748-5348

Mailing address

1016 E North Blvd
Leesburg, FL 34748-5348
Phone (352) 874-2986

National Provider Directory

National Provider Directory

Locations

1016 E North Blvd
Leesburg, FL 34748
Phone (352) 435-0122

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1144844119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 E NORTH BLVD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485348",
            "telephone_number": "352-874-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 E NORTH BLVD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485348",
            "telephone_number": "352-874-2986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT BEHAVIOR SUPPORTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-04",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOCELYN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-874-2986",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.