Healthcare Provider Details

I. General information

NPI: 1407654627
Provider Name (Legal Business Name): IMAGINE HEALING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W MORRIS AVE STE C
HAMMOND LA
70403-4150
US

IV. Provider business mailing address

406 W MORRIS AVE STE C
HAMMOND LA
70403-4150
US

V. Phone/Fax

Practice location:
  • Phone: 985-205-8822
  • Fax: 985-467-5787
Mailing address:
  • Phone: 985-205-8822
  • Fax: 985-467-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE STARKEY
Title or Position: MANAGER, MEMBER
Credential: PHD, LPC
Phone: 985-634-8313