Organization
INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INC
Active
Parent organization
INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INC
Other names
IMPACT BEHAVIORAL HEALTH LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INC
Authorized official
YVETTE MIGNON MD (OWNER)
(850) 656-2006
Entity
Organization
Contact information
Practice address
1965 CAPITAL CIR NE, SUITE 102, TALLAHASSEE, FL 32308-8401
(850) 671-4600
(850) 878-2863
Mailing address
1965 CAPITAL CIR NE STE 200, TALLAHASSEE, FL 32308-8402
(850) 656-2006
(850) 656-2820
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
8447
FL
101YM0800X
Mental Health Counselor
8447
FL
104100000X
Social Worker
6702
FL
1041C0700X
Clinical Social Worker
6702
FL
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
FL
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003214900
—
FL
01
—
2386
LICENSED PROFESSIONAL COUNSELOR
GA
01
—
600680931
MAGELLAN
FL
05
—
648299630A
—
GA
01
—
8447
LICENSED MENTAL HEALTH COUNSELOR
FL
Enumeration date
05/16/2010
Last updated
12/01/2017
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