| Impact Counseling Consulting Llc | |
|
4 Avis Ave Pueblo CO 81005-3102 | |
| (719) 256-1327 | |
| Not Available |
| Full Name | Impact Counseling Consulting Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4 Avis Ave, Pueblo, Colorado |
| Authorized Official Name and Position | Myra Fairline Ricketts (DIRECTOR) |
| Authorized Official Contact | 3525872378 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Counseling Consulting Llc 4 Avis Ave Pueblo CO 81005-3102 Ph: (719) 256-1327 | Impact Counseling Consulting Llc 4 Avis Ave Pueblo CO 81005-3102 Ph: (719) 256-1327 |
| NPI Number | 1366151730 |
|---|---|
| Provider Enumeration Date | 11/15/2022 |
| Last Update Date | 11/15/2022 |
| Certification Date | 11/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366151730 | NPI | - | NPPES |
| 9000202666 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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