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General NPI Number Information
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NPI Number | 1407654627
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Entity Type | Organization
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Legal Business Name | IMAGINE HEALING THERAPY
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 406 W MORRIS AVE STE C
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City | HAMMOND
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State | LA
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Zip | 70403-4150
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Country | US
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Telephone | 985-205-8822
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Fax | 985-467-5787
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Provider Business Mailing Address
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Address Line | 406 W MORRIS AVE STE C
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City | HAMMOND
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State | LA
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Zip | 70403-4150
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Country | US
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Telephone | 985-205-8822
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Fax | 985-467-5787
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Authorized Official
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Title or Position | MANAGER, MEMBER
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Name | MICHELLE STARKEY
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Credential | PHD, LPC
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Telephone | 985-634-8313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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