Impact Therapy, LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

933549 Issued in OH

Legal business name

IMPACT THERAPY, LLC

Practice address

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

Phone

(567) 288-6769

NPI assigned

Dec 4, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Lamarr J Norwood, LICDC-CS

Title

Ceo

Phone

(567) 288-6769

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

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

{
    "created_epoch": "1386115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1881025641",
    "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": "567-288-6769"
        },
        {
            "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": "567-288-6769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-04",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "NORWOOD",
        "authorized_official_first_name": "LAMARR",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "567-288-6769",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICDC-CS"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "933549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Toledo, OH
• Providers in Toledo, OH by specialty
• Addiction (Substance Use Disorder) 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.