Provider Demographics
NPI:1740520345
Name:IMPACT CHILD AND FAMILY THERAPIES INC
Entity type:Organization
Organization Name:IMPACT CHILD AND FAMILY THERAPIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO DIRECTOR AND EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-275-9498
Mailing Address - Street 1:829 S GREEN BAY RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4058
Mailing Address - Country:US
Mailing Address - Phone:262-497-6212
Mailing Address - Fax:
Practice Address - Street 1:829 S GREEN BAY RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4058
Practice Address - Country:US
Practice Address - Phone:262-497-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7963-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty