NPIMap

Organization Active NPI

Impact Behavior Health Services, LLC

  • Community/Behavioral Health Agency
  • Baton Rouge, LA
National Provider Identifier
1871952184
Registry record updated Nov 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
IMPACT BEHAVIOR HEALTH SERVICES, LLC
Practice address
12147 Coursey Blvd
Suite B
Baton Rouge, LA 70816-4410
Phone
(225) 771-8849
Fax
(225) 771-8876
NPI assigned
Feb 15, 2016
Last updated
Nov 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2020

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

Authorized official

Name
John A Clark
Title
Ceo
Phone
(504) 304-4097

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X LA Primary

Addresses

Primary practice location

12147 Coursey Blvd
Suite B
Baton Rouge, LA 70816-4410

Mailing address

1406 Esplanade Ave
New Orleans, LA 70116-1803
Phone (504) 304-4097

National Provider Directory

National Provider Directory
Tax ID family
Impact Behavior Health Services LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

12147 Coursey Blvd
Ste B
Baton Rouge, LA 70816
Phone (225) 771-8149

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604707200000",
    "number": "1871952184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 ESPLANADE AVE",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701161803",
            "telephone_number": "504-304-4097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12147 COURSEY BLVD",
            "address_2": "SUITE B",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708164410",
            "telephone_number": "225-771-8849",
            "fax_number": "225-771-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT BEHAVIOR HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-15",
        "last_updated": "2020-11-07",
        "certification_date": "2020-11-07",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "504-304-4097"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.