Provider Demographics
NPI:1891270286
Name:IMPAC CHRISTIAN PASTORAL COUNSELING MINISTRY
Entity Type:Organization
Organization Name:IMPAC CHRISTIAN PASTORAL COUNSELING MINISTRY
Other - Org Name:IMPAC CHRISTIAN COUNSELING, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:POWER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:929-434-9498
Mailing Address - Street 1:77 SANDS ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1431
Mailing Address - Country:US
Mailing Address - Phone:929-434-9498
Mailing Address - Fax:
Practice Address - Street 1:77 SANDS ST FL 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1431
Practice Address - Country:US
Practice Address - Phone:929-434-9498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No282J00000XHospitalsReligious Nonmedical Health Care InstitutionGroup - Multi-Specialty