Provider Demographics
NPI:1346860608
Name:IMPACT BEHAVIOR THERAPY LLC
Entity Type:Organization
Organization Name:IMPACT BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:215-350-7236
Mailing Address - Street 1:1720 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3156
Mailing Address - Country:US
Mailing Address - Phone:215-350-7236
Mailing Address - Fax:272-400-2026
Practice Address - Street 1:1720 WATERFORD WAY
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3156
Practice Address - Country:US
Practice Address - Phone:215-350-7236
Practice Address - Fax:272-400-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health