NPIMap

Organization Active NPI

Impact Therapy, LLC

  • Behavior Analyst
  • Tallahassee, FL
National Provider Identifier
1639749674
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
IMPACT THERAPY, LLC
Practice address
1717 Hermitage Blvd
Tallahassee, FL 32308-7709
Phone
(850) 325-6301
Fax
(850) 325-6302
NPI assigned
Jul 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Kelly Quin Prejean, MA, CCC-SLP
Title
Clinic Director
Phone
(850) 325-6301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

1717 Hermitage Blvd
Tallahassee, FL 32308-7709

Mailing address

1717 Hermitage Blvd
Tallahassee, FL 32308-7709
Phone (850) 325-6301

National Provider Directory

National Provider Directory
Tax ID family
Impact Therapy LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1625097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1639749674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 HERMITAGE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323087709",
            "telephone_number": "850-325-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 HERMITAGE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323087709",
            "telephone_number": "850-325-6301",
            "fax_number": "850-325-6302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-01",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "PREJEAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "QUIN",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "850-325-6301",
        "authorized_official_credential": "MA, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.