NPIMap

Organization Active NPI

Imagine Wellness, LLC

  • Behavior Analyst
  • Laurel, MD
National Provider Identifier
1396082657
Registry record updated Dec 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-11-8182 Issued in MD
Legal business name
IMAGINE WELLNESS, LLC
Practice address
7909 Belgaro Rd
Laurel, MD 20723-1108
Phone
(443) 741-2249
Fax
(301) 725-4608
NPI assigned
Jan 7, 2013
Last updated
Dec 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Crystal Marie Wissinger, M.S., LBA, BCBA
Title
Owner/Founder
Phone
(443) 741-2249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X 1-11-8182 MD Primary

Addresses

Primary practice location

7909 Belgaro Rd
Laurel, MD 20723-1108

Mailing address

7909 Belgaro Rd
Laurel, MD 20723-1108
Phone (443) 741-2249

National Provider Directory

National Provider Directory

Locations

9194 Red Branch Rd
Ste B
Columbia, MD 21045

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482278400000",
    "number": "1396082657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7909 BELGARO RD",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207231108",
            "telephone_number": "443-741-2249",
            "fax_number": "301-725-4608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7909 BELGARO RD",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207231108",
            "telephone_number": "443-741-2249",
            "fax_number": "301-725-4608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-07",
        "last_updated": "2016-12-21",
        "status": "A",
        "authorized_official_last_name": "WISSINGER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/FOUNDER",
        "authorized_official_telephone_number": "443-741-2249",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S., LBA, BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "MD",
            "license": "1-11-8182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.