NPIMap

Organization Active NPI

Impact Counseling Services, Inc.

  • Mental Health Counselor
  • Georgetown, TX
National Provider Identifier
1396312658
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
IMPACT COUNSELING SERVICES, INC.
Doing business as
Impact Counseling Services, Inc.
Practice address
3613 Williams Dr Ste 302
Georgetown, TX 78628-1369
Phone
(512) 713-9886
Fax
(737) 277-5546
NPI assigned
Jun 7, 2021
Last updated
Jul 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Authorized official

Name
Candi Gadison, LCSWNPI 1265735302
Title
Executive Director
Phone
(512) 713-9886

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
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

3613 Williams Dr Ste 302
Georgetown, TX 78628-1369

Mailing address

3613 Williams Dr Ste 302
Georgetown, TX 78628-1369
Phone (512) 713-9886

Other practice location 1

805 W University Ave
Georgetown, TX 78626-6507
Phone (512) 713-9886

Other identifiers 1

IdentifierTypeStateIssuer
NONEOtherTXN/A

Other names 1

  • Impact Counseling Services, Inc. Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL 7372775546 Health Information Exchange (HIE) Impact Counseling Services, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241028001387 TX Part B Supplier - Clinic/Group Practice 4284167438 Receives reassigned benefits from 1 practitioner
Practice locations: Georgetown, TX

National Provider Directory

National Provider Directory

Locations

2100 Scenic Dr
Ste 140
Georgetown, TX 78626
Phone (512) 713-9886

3613 Williams Dr
Ste 302
Georgetown, TX 78628
Phone (512) 317-9763

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1396312658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3613 WILLIAMS DR STE 302",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281369",
            "telephone_number": "512-713-9886",
            "fax_number": "737-277-5546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3613 WILLIAMS DR STE 302",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281369",
            "telephone_number": "512-713-9886",
            "fax_number": "737-277-5546"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 W University Ave",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "TX",
            "postal_code": "786266507",
            "country_code": "US",
            "telephone_number": "512-713-9886",
            "fax_number": "737-277-5546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT COUNSELING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-07",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "GADISON",
        "authorized_official_first_name": "CANDI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "512-713-9886",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "NONE",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "7372775546",
            "affiliation": "Y",
            "endpointDescription": "Fax",
            "affiliationName": "Impact Counseling Services, Inc.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3613 Williams Dr Ste 302",
            "city": "Georgetown",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786281369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Impact Counseling Services, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.