Organization
IMPACT BEHAVIORAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN A WALLACE MS (OWNER)
(260) 740-5139
Entity
Organization
Contact information
Practice address
4606 E STATE BLVD, FORT WAYNE, IN 46815-6993
(260) 740-5139
Mailing address
2918 ELMWOOD CT, FORT WAYNE, IN 46804-6100
(260) 740-5139
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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