Basic Information
| Provider Information | |||||||||
| NPI: | 1740645811 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMAGINE ME COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9100 OVERLAND PLZ | ||||||||
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| City: | OVERLAND | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631146123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147449027 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9100 OVERLAND PLZ | ||||||||
| Address2: | |||||||||
| City: | OVERLAND | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631146123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147449027 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2015 | ||||||||
| LastUpdateDate: | 12/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | RACHELLE | ||||||||
| AuthorizedOfficialMiddleName: | DELORES | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3147449027 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD, LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2010009689 | MO | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.