NPIMap

Organization Active NPI

Impact Counseling Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hayward, WI
National Provider Identifier
1346419082
Registry record updated Aug 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
42213900 Issued in WI
Legal business name
IMPACT COUNSELING SERVICES, LLC
Practice address
15655 County Road B
Hayward, WI 54843-3251
Phone
(715) 634-0607
Fax
(715) 634-0617
NPI assigned
Feb 27, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2008

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

Authorized official

Name
Ms. Renee Marie Millwood, MS, LCSW
Title
Director
Phone
(715) 634-0607

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 42213900 WI Primary

Addresses

Primary practice location

15655 County Road B
Hayward, WI 54843-3251

Mailing address

15655 County Hwy B
P.O. Box 13251
Hayward, WI 54843
Phone (715) 634-0607

Other identifiers 1

IdentifierTypeStateIssuer
42213900MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1346419082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15655 COUNTY HWY B",
            "address_2": "P.O. BOX 13251",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "54843",
            "telephone_number": "715-634-0607",
            "fax_number": "715-634-0617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15655 COUNTY ROAD B",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548433251",
            "telephone_number": "715-634-0607",
            "fax_number": "715-634-0617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-27",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "MILLWOOD",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-634-0607",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "42213900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42213900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayward, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; 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.