Basic Information
| Provider Information | |||||||||
| NPI: | 1740387877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPACT INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2207 OLYMPIC ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455032736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373907773 | ||||||||
| FaxNumber: | 3903908765 | ||||||||
| Practice Location | |||||||||
| Address1: | 2207 OLYMPIC ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455032736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373907773 | ||||||||
| FaxNumber: | 3903908765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | HENSEL | ||||||||
| AuthorizedOfficialMiddleName: | OWEN | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9373907773 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4444 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.