NPIMap

Organization Active NPI

Impact Counseling Clinic, Incorporated

  • Adolescent and Children Mental Health Clinic/Center
  • Dierks, AR
National Provider Identifier
1205388071
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
IMPACT COUNSELING CLINIC, INCORPORATED
Practice address
1124 Main Ave
Dierks, AR 71833-9421
Phone
(870) 285-1413
Fax
(870) 825-2060
NPI assigned
Oct 27, 2016
Last updated
Aug 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Authorized official

Name
Mrs. Priscilla Ann Faulkner, LPCNPI 1457594848
Title
Ceo
Phone
(870) 285-1413

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary
Mental Health Counselor 101YM0800X

Addresses

Primary practice location

1124 Main Ave
Dierks, AR 71833-9421

Mailing address

PO Box 575
Dierks, AR 71833-0575
Phone (870) 285-1413

Other practice location 1

1123 Main Avenue
Dierks, AR 71833
Phone (870) 285-1413

National Provider Directory

National Provider Directory
Tax ID family
Impact Counseling Clinic Incorporated2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1123 Main Ave
Dierks, AR 71833
Phone (870) 285-1413

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25972/brand/1/csg/1/fhir/r4

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1205388071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 575",
            "city": "DIERKS",
            "state": "AR",
            "postal_code": "718330575",
            "telephone_number": "870-285-1413",
            "fax_number": "870-825-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 MAIN AVE",
            "city": "DIERKS",
            "state": "AR",
            "postal_code": "718339421",
            "telephone_number": "870-285-1413",
            "fax_number": "870-825-2060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1123 Main Avenue",
            "address_purpose": "LOCATION",
            "city": "Dierks",
            "state": "AR",
            "postal_code": "71833",
            "country_code": "US",
            "telephone_number": "870-285-1413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT COUNSELING CLINIC, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-285-1413",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dierks, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.