Healthcare Provider Details

I. General information

NPI: 1740645811
Provider Name (Legal Business Name): IMAGINE ME COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 OVERLAND PLZ
OVERLAND MO
63114-6123
US

IV. Provider business mailing address

9100 OVERLAND PLZ
OVERLAND MO
63114-6123
US

V. Phone/Fax

Practice location:
  • Phone: 314-744-9027
  • Fax:
Mailing address:
  • Phone: 314-744-9027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010009689
License Number StateMO

VIII. Authorized Official

Name: DR. RACHELLE DELORES SMITH
Title or Position: CEO
Credential: PHD, LPC
Phone: 314-744-9027