NPIMap

Organization Active NPI

Impact Counseling Clinic, Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Glenwood, AR
National Provider Identifier
1801673405
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
IMPACT COUNSELING CLINIC, INCORPORATED
Practice address
408 N 1St St Ste C
Glenwood, AR 71943-9252
Phone
(870) 356-7404
Fax
(870) 825-2060
NPI assigned
Sep 8, 2023
Last updated
Sep 8, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
IMPACT COUNSELING CLINIC, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Authorized official

Name
Priscilla Ann Faulkner, LPCNPI 1457594848
Title
Ceo
Phone
(870) 285-1413

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

408 N 1St St Ste C
Glenwood, AR 71943-9252

Mailing address

PO Box 416
Dierks, AR 71833-0416
Phone (870) 285-1413

National Provider Directory

National Provider Directory
Tax ID family
Impact Counseling Clinic Incorporated2 organizations share this tax ID, including this one
Part of
Impact Counseling Clinic Incorporated

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1694131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1801673405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416",
            "city": "DIERKS",
            "state": "AR",
            "postal_code": "718330416",
            "telephone_number": "870-285-1413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 N 1ST ST STE C",
            "city": "GLENWOOD",
            "state": "AR",
            "postal_code": "719439252",
            "telephone_number": "870-356-7404",
            "fax_number": "870-825-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT COUNSELING CLINIC, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMPACT COUNSELING CLINIC, INCORPORATED",
        "enumeration_date": "2023-09-08",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "FAULKNER",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-285-1413",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenwood, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.