Provider Demographics
NPI:1780901702
Name:IMAGINE THERAPIES, LLC
Entity type:Organization
Organization Name:IMAGINE THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:DOEGEY
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:210-995-6918
Mailing Address - Street 1:14314 DUSKY THRUSH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5383
Mailing Address - Country:US
Mailing Address - Phone:210-995-6918
Mailing Address - Fax:
Practice Address - Street 1:14314 DUSKY THRUSH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-5383
Practice Address - Country:US
Practice Address - Phone:210-995-6918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44621225800000X
TX06122225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty