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General NPI Number Information
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NPI Number | 1851214761
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Entity Type | Organization
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Legal Business Name | IMAGO DEI COLLECTIVE INC
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 35210 AVENUE A
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City | YUCAIPA
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State | CA
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Zip | 92399-4325
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Country | US
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Telephone | 909-769-6593
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Fax |
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Provider Business Mailing Address
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Address Line | 35210 AVENUE A
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City | YUCAIPA
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State | CA
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Zip | 92399-4325
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Country | US
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Telephone | 909-769-6593
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Fax | 909-253-0199
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Authorized Official
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Title or Position | PRESIDENT
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Name | CANDACE DEESE
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Credential | LMFT
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Telephone | 909-769-6593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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