Imagine Change Counseling and Psychotherapy, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

IMAGINE CHANGE COUNSELING AND PSYCHOTHERAPY, PLLC

Practice address

1822 E Bluefield Ave
Phoenix, AZ 85022-1324

Phone

(424) 298-0560

NPI assigned

Aug 9, 2021

Last updated

Aug 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shannon Jacobson, LMSWNPI 1225510688

Title

Owner

Phone

(424) 298-0560

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shannon Kris Jacobson, MSW

  • Social Worker
  • Los Angeles, CA
  • NPI 1225510688
  NPD Authorized official

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1649945023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1822 E BLUEFIELD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850221324",
            "telephone_number": "424-298-0560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1822 E BLUEFIELD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850221324",
            "telephone_number": "424-298-0560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGINE CHANGE COUNSELING AND PSYCHOTHERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "424-298-0560",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; 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.