Provider Demographics
NPI:1881025641
Name:IMPACT THERAPY, LLC
Entity Type:Organization
Organization Name:IMPACT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMARR
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC-CS
Authorized Official - Phone:567-288-6769
Mailing Address - Street 1:3450 W CENTRAL AVE STE 354
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1418
Mailing Address - Country:US
Mailing Address - Phone:567-288-6769
Mailing Address - Fax:
Practice Address - Street 1:3450 W CENTRAL AVE STE 354
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1418
Practice Address - Country:US
Practice Address - Phone:567-288-6769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH933549101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty