Impact Education & Therapy, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

603324417 Issued in WA

Legal business name

IMPACT EDUCATION & THERAPY, LLC

Practice address

4945 Mission Rd
Bellingham, WA 98226-9528

Phone

(304) 319-0581

Fax

(888) 972-8992

NPI assigned

Jan 29, 2011

Last updated

Dec 12, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Rives W Thornton, M.S. LMHCANPI 1417356908

Title

Member

Phone

(304) 319-0581

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 3

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.

• Rives Thornton

  • Counselor
  • Bellingham, WA
  • NPI 1417356908
  NPD Authorized official
• Nina Ida Marie Spadaro, ED.D.

  • Psychologist
  • Bellingham, WA
  • NPI 1134285968
  Medicare reassignment
• Christopher A Sinclair

  • Mental Health Counselor
  • Spokane, WA
  • NPI 1033927785
  NPD

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

{
    "created_epoch": "1296259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481500800000",
    "number": "1518263144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4945 MISSION RD",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982269528",
            "telephone_number": "304-319-0581",
            "fax_number": "888-972-8992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4945 MISSION RD",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982269528",
            "telephone_number": "304-319-0581",
            "fax_number": "888-972-8992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT EDUCATION & THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-29",
        "last_updated": "2016-12-12",
        "status": "A",
        "authorized_official_last_name": "THORNTON",
        "authorized_official_first_name": "RIVES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "304-319-0581",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S. LMHCA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "603324417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Community/Behavioral Health Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; 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.