| Organization Name: | IMPACT COUNSELING CENTER LLC |
| NPI Number: | 1730583402 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHALON MARGARET STOKES (CHIEF EXECUTIVE DIRECTOR) |
| Mailing Address: | 115 S Main St Noble |
| State: | OK US |
| Postal Code: | 730689596 |
| Phone Number: | 4058728461 |
| Fax Number: | 4058728466 |
| NPI Enumeration Date: | 10/09/2014 |
| NPI Last Update Date: | 10/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 955 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |