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General NPI Number Information
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NPI Number | 1922570878
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Entity Type | Organization
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Legal Business Name | IMAGINE THERAPY
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 250 N LITCHFIELD RD STE 260
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City | GOODYEAR
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State | AZ
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Zip | 85338-1369
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Country | US
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Telephone | 623-337-2275
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7405
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City | GOODYEAR
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State | AZ
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Zip | 85338-0641
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Country | US
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Telephone | 623-337-2275
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MRS. PATRICIA ANN PLUM
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Credential | LCSW
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Telephone | 623-337-2275
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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