Organization
IMPACT COUNSELING AND CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MYRA FAIRLINE RICKETTS LMHC (OWNER)
(352) 587-2378
Entity
Organization
Contact information
Practice address
3404 N LECANTO HWY STE D, BEVERLY HILLS, FL 34465-3569
(352) 587-2378
Mailing address
PO BOX 2581, INVERNESS, FL 34451-2581
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH16109
FL
251S00000X
Community/Behavioral Health Agency
Primary
MH16109
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017033-00
—
FL
Enumeration date
07/06/2018
Last updated
03/17/2023
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