Provider Demographics
NPI:1679039671
Name:T3 IMPACT INC.
Entity Type:Organization
Organization Name:T3 IMPACT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:317-640-9936
Mailing Address - Street 1:124 E NORTHFIELD DR STE F224
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2600
Mailing Address - Country:US
Mailing Address - Phone:317-525-0835
Mailing Address - Fax:
Practice Address - Street 1:3710 NUTHATCHER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-1089
Practice Address - Country:US
Practice Address - Phone:173-663-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty