Provider Demographics
NPI:1225851678
Name:IMPACT MENTAL HEALTH THERAPY LLC
Entity type:Organization
Organization Name:IMPACT MENTAL HEALTH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SYDNIE
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMHP
Authorized Official - Phone:402-326-8579
Mailing Address - Street 1:7041 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7041 GARLAND ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1445
Practice Address - Country:US
Practice Address - Phone:402-326-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)