Provider Demographics
NPI:1528600954
Name:IMPRESSIONS COUNSELING LLC
Entity Type:Organization
Organization Name:IMPRESSIONS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVIA
Authorized Official - Middle Name:RAYLENE
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:432-425-6978
Mailing Address - Street 1:9460 W WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-8923
Mailing Address - Country:US
Mailing Address - Phone:432-425-6978
Mailing Address - Fax:
Practice Address - Street 1:1901 E 37TH ST STE 111E
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-6216
Practice Address - Country:US
Practice Address - Phone:432-425-6978
Practice Address - Fax:432-366-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health