Provider Demographics
NPI:1083202618
Name:IMAGO BEHAVIORAL CONSULTING
Entity Type:Organization
Organization Name:IMAGO BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KANDACE
Authorized Official - Middle Name:EM
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:254-338-1158
Mailing Address - Street 1:421 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1120
Mailing Address - Country:US
Mailing Address - Phone:254-338-1158
Mailing Address - Fax:
Practice Address - Street 1:421 COOPER AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1120
Practice Address - Country:US
Practice Address - Phone:254-338-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health