Provider Demographics
NPI:1740958370
Name:IMAGINE APPLIED BEHAVIOR ANALYSIS LLC
Entity type:Organization
Organization Name:IMAGINE APPLIED BEHAVIOR ANALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:205-468-0993
Mailing Address - Street 1:164 STRICKLIN RD
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-3305
Mailing Address - Country:US
Mailing Address - Phone:256-469-8493
Mailing Address - Fax:
Practice Address - Street 1:164 STRICKLIN RD
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35057-3305
Practice Address - Country:US
Practice Address - Phone:256-469-8493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty