Provider Demographics
NPI:1841763307
Name:IMS, LLC
Entity Type:Organization
Organization Name:IMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:INGER
Authorized Official - Middle Name:MAI
Authorized Official - Last Name:SJOGREN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-493-6557
Mailing Address - Street 1:35 GRAENEST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2929
Mailing Address - Country:US
Mailing Address - Phone:203-247-7546
Mailing Address - Fax:
Practice Address - Street 1:225 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3216
Practice Address - Country:US
Practice Address - Phone:203-493-6557
Practice Address - Fax:203-762-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881130631OtherINDIVIDUAL NPI
CT3530OtherLPC LICENSE