Provider Demographics
NPI:1851749220
Name:IMPACT COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:IMPACT COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE-MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:713-294-2439
Mailing Address - Street 1:2616 S LOOP W STE 260
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-0005
Mailing Address - Country:US
Mailing Address - Phone:713-666-7779
Mailing Address - Fax:
Practice Address - Street 1:2616 S LOOP W STE 260
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-0005
Practice Address - Country:US
Practice Address - Phone:713-666-7779
Practice Address - Fax:832-200-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 1041C0700X, 261QM1300X, 324500000X
TX17269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361402605Medicaid
TX361402604Medicaid
TX361402603Medicaid