Healthcare Provider Details

I. General information

NPI: 1922570878
Provider Name (Legal Business Name): IMAGINE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N LITCHFIELD RD STE 260
GOODYEAR AZ
85338-1369
US

IV. Provider business mailing address

PO BOX 7405
GOODYEAR AZ
85338-0641
US

V. Phone/Fax

Practice location:
  • Phone: 623-337-2275
  • Fax:
Mailing address:
  • Phone: 623-337-2275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA ANN PLUM
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 623-337-2275