NPIMap

Organization Active NPI

Impact Counseling and Consulting LLC

  • Community/Behavioral Health Agency
  • Inverness, FL
National Provider Identifier
1487320883
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
IMPACT COUNSELING AND CONSULTING LLC
Practice address
110 S Apopka Ave
Inverness, FL 34452-4837
Phone
(362) 560-7027
NPI assigned
Aug 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Authorized official

Name
Myra Fairline Ricketts
Title
Owner
Phone
(352) 587-2378

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

110 S Apopka Ave
Inverness, FL 34452-4837

Mailing address

110 S Apopka Ave
Inverness, FL 34452-4837

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210922003409 FL Part B Supplier - Clinic/Group Practice 0042617730 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Crystal River, FL; Beverly Hills, FL; Inverness, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Impact Counseling and Consulting 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.

Locations

3404 N Lecanto Hwy
Ste D
Beverly Hills, FL 34465
Phone (352) 419-4856

110 S Apopka Ave
Inverness, FL 34452
Phone (352) 419-4856

Practitioners & affiliated clinicians

Practitioners 4

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": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1487320883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S APOPKA AVE",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344524837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S APOPKA AVE",
            "city": "INVERNESS",
            "state": "FL",
            "postal_code": "344524837",
            "telephone_number": "362-560-7027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COUNSELING AND CONSULTING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "RICKETTS",
        "authorized_official_first_name": "MYRA",
        "authorized_official_middle_name": "FAIRLINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-587-2378"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Inverness, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.