Provider Demographics
NPI:1821480013
Name:IMAGINE BEHAVIORAL SERVICES CA, LLC
Entity Type:Organization
Organization Name:IMAGINE BEHAVIORAL SERVICES CA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF AUTISM & BEHAVIORAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:QUINANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-328-2740
Mailing Address - Street 1:5709 W SUNSET HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-6005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19300 S HAMILTON AVE
Practice Address - Street 2:#130
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4400
Practice Address - Country:US
Practice Address - Phone:310-327-7842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty