| Imagine, Llc | |
|
1920 Dunbarton Dr Jackson MS 39216-5001 | |
| (601) 982-5376 | |
| (601) 982-5377 |
| Full Name | Imagine, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1920 Dunbarton Dr, Jackson, Mississippi |
| Authorized Official Name and Position | Baxter Hugh Hogue (PRESIDENT) |
| Authorized Official Contact | 6012594081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagine, Llc 1920 Dunbarton Dr Jackson MS 39216-5001 Ph: (601) 982-5376 | Imagine, Llc 1920 Dunbarton Dr Jackson MS 39216-5001 Ph: (601) 982-5376 |
| NPI Number | 1902052962 |
|---|---|
| Provider Enumeration Date | 08/11/2008 |
| Last Update Date | 11/05/2024 |
| Certification Date | 11/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902052962 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 1093 (Mississippi) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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