Provider Demographics
NPI:1467899666
Name:IMAGINE CENTER LLC
Entity Type:Organization
Organization Name:IMAGINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BEHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-354-3920
Mailing Address - Street 1:100 MAINCENTRE
Mailing Address - Street 2:STE. 16
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1578
Mailing Address - Country:US
Mailing Address - Phone:313-354-3920
Mailing Address - Fax:
Practice Address - Street 1:100 MAINCENTRE
Practice Address - Street 2:STE. 16
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1578
Practice Address - Country:US
Practice Address - Phone:313-354-3920
Practice Address - Fax:313-656-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty