Provider Demographics
NPI:1659625127
Name:IMPACT BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:IMPACT BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:YILMAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-238-2292
Mailing Address - Street 1:1410 W ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4445
Mailing Address - Country:US
Mailing Address - Phone:623-238-2292
Mailing Address - Fax:
Practice Address - Street 1:18444 N 25TH AVE STE 420
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-1268
Practice Address - Country:US
Practice Address - Phone:480-256-2788
Practice Address - Fax:480-535-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ370362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ237334Medicaid
AZZ146793Medicare UPIN