Healthcare Provider Details

I. General information

NPI: 1902052962
Provider Name (Legal Business Name): IMAGINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 DUNBARTON DR
JACKSON MS
39216-5001
US

IV. Provider business mailing address

1920 DUNBARTON DR
JACKSON MS
39216-5001
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-5376
  • Fax: 601-982-5377
Mailing address:
  • Phone: 601-982-5376
  • Fax: 601-982-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1093
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BAXTER HUGH HOGUE
Title or Position: PRESIDENT
Credential: LPC
Phone: 601-259-4081