Impact Child and Family Therapies Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7963-123 Issued in WI

Legal business name

IMPACT CHILD AND FAMILY THERAPIES INC

Practice address

829 S Green Bay Rd
Suite 108
Mount Pleasant, WI 53406-4058

Phone

(262) 497-6212

NPI assigned

Feb 20, 2013

Organization subpart

No

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

Authorized official

Name

Mr. William Paul Stewart, LCSW

Title

Co Director and Executive Officer

Phone

(847) 275-9498

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1361318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361318400000",
    "number": "1740520345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 S GREEN BAY RD",
            "address_2": "SUITE 108",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064058",
            "telephone_number": "262-497-6212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 S GREEN BAY RD",
            "address_2": "SUITE 108",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064058",
            "telephone_number": "262-497-6212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT CHILD AND FAMILY THERAPIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-20",
        "last_updated": "2013-02-20",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CO DIRECTOR AND EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "847-275-9498",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7963-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; 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.