Internal Medicine And Pediatrics Associatesof Tallahassee Inc
May also be knows as Impact Behavioral Health Llc
Substance Abuse Rehabilitation Facility in Tallahassee, FL(View on Map)
Legal Business Name
Internal Medicine And Pediatrics Associatesof Tallahassee Inc
Also Known As
Impact Behavioral Health Llc
NPI Number
1982922829
NPI Type
Organization
Enumeration Date
05/16/2010
Specialties
(Taxonomies)Name
Code
324500000X
1041C0700X
101Y00000X
101YM0800X
104100000X
Primary Taxonomy
Yes
No
No
No
No
Licenses
State
Florida
Florida
License Number
6702
8447
Contact
Information
Purpose
Mailing
Location
Address
1965 CAPITAL CIR NE STE 200
1965 CAPITAL CIR NE
City
Tallahassee
Tallahassee
State
FL
FL
Postal Code
32308-8402
32308-8401
Country
US
US
Telephone Number
(850) 656-2006
(850) 671-4600
Authorized Official
Name
Yvette Mignon
Title or Position
OWNER
Telephone Number
(850) 656-2006
Identifiers
Identifier
600680931
2386
648299630A
003214900
8447
Identifier State
FL
GA
GA
FL
FL
Identifier Issuer
MAGELLAN
LICENSED PROFESSIONAL COUNSELOR
Unknown
Unknown
LICENSED MENTAL HEALTH COUNSELOR
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 12/01/2017
Provider Address
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