NPIMap

Organization Active NPI

Impact Counseling Services, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Hayward, WI
National Provider Identifier
1437323680
Registry record updated Aug 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
43005300 Issued in WI
Legal business name
IMPACT COUNSELING SERVICES, LLC
Practice address
15655 County Road B
Hayward, WI 54843-3251
Phone
(715) 634-0607
NPI assigned
Apr 18, 2008
Last updated
Aug 11, 2008By the provider in NPPES
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
Renee M Millwood, MSNPI 1306983465
Title
Director
Phone
(715) 634-0607

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 43005300 WI Primary

Addresses

Primary practice location

15655 County Road B
Hayward, WI 54843-3251

Mailing address

15655 County Road B
PO Box 13251
Hayward, WI 54843-3251
Phone (715) 634-0607

Other identifiers 1

IdentifierTypeStateIssuer
43005300MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Impact Counseling Services LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1437323680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15655 COUNTY ROAD B",
            "address_2": "PO BOX 13251",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548433251",
            "telephone_number": "715-634-0607"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "MILLWOOD",
        "authorized_official_first_name": "RENEE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-634-0607",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "43005300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43005300",
            "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.