Provider Demographics
NPI:1518263144
Name:IMPACT EDUCATION & THERAPY, LLC
Entity Type:Organization
Organization Name:IMPACT EDUCATION & THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIVES
Authorized Official - Middle Name:W
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHCA
Authorized Official - Phone:304-319-0581
Mailing Address - Street 1:4945 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9528
Mailing Address - Country:US
Mailing Address - Phone:304-319-0581
Mailing Address - Fax:888-972-8992
Practice Address - Street 1:4945 MISSION RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9528
Practice Address - Country:US
Practice Address - Phone:304-319-0581
Practice Address - Fax:888-972-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-29
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603324417251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty