Impact Therapy, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

01-7629 Issued in OH

Legal business name

IMPACT THERAPY, LLC

Practice address

3450 W Central Ave Ste 354
Toledo, OH 43606-1418

Phone

(419) 407-5578

Fax

(844) 272-8238

NPI assigned

Aug 21, 2018

Last updated

Jan 9, 2020By 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

Mrs. Kim Oats, LICDC-CSNPI 1568853372

Title

Administrator

Phone

(419) 349-6011

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

Practitioners 1

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.

• Kim Oats, LICDC-CS

  • Addiction (Substance Use Disorder) Counselor
  • Toledo, OH
  • NPI 1568853372
  Authorized official Same address or phone

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

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1851871677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 W CENTRAL AVE STE 354",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436061418",
            "telephone_number": "419-407-5578",
            "fax_number": "844-272-8238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 W CENTRAL AVE STE 354",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436061418",
            "telephone_number": "419-407-5578",
            "fax_number": "844-272-8238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-21",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "OATS",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "419-349-6011",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICDC-CS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "01-7629",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO MENTAL HEALTH AND ADDICTION SERVICES BOARD",
            "identifier": "01-7629",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0301404",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115549",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Toledo, OH
• Providers in Toledo, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; 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.