Organization
IMPACT THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM OATS LICDC-CS (ADMINISTRATOR)
(419) 349-6011
Entity
Organization
Contact information
Practice address
3450 W CENTRAL AVE STE 354, TOLEDO, OH 43606-1418
(419) 407-5578
(844) 272-8238
Mailing address
3450 W CENTRAL AVE STE 354, TOLEDO, OH 43606-1418
(419) 407-5578
(844) 272-8238
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
01-7629
OH
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-7629
OHIO MENTAL HEALTH AND ADDICTION SERVICES BOARD
OH
05
—
0115549
—
OH
05
—
0301404
—
OH
Enumeration date
08/21/2018
Last updated
01/09/2020
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