Provider Demographics
NPI:1295819662
Name:IMAGING MENTAL HEALTH
Entity Type:Organization
Organization Name:IMAGING MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VOIGT
Authorized Official - Suffix:
Authorized Official - Credentials:MA ATRBC LPAT LPCC
Authorized Official - Phone:505-627-0439
Mailing Address - Street 1:200 W 1ST
Mailing Address - Street 2:STE 532
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203
Mailing Address - Country:US
Mailing Address - Phone:505-627-0439
Mailing Address - Fax:505-622-2750
Practice Address - Street 1:200 W 1ST
Practice Address - Street 2:STE 532
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203
Practice Address - Country:US
Practice Address - Phone:505-627-0439
Practice Address - Fax:505-622-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101YP2500X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty