Organization
IMAGINE PROGRAMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN WILMUT (CLINICAL DIRECTOR)
(972) 423-6007
Entity
Organization
Contact information
Practice address
1947 K AVE, BUILDING A STE 100, PLANO, TX 75074-5961
(972) 423-6007
Mailing address
1947 K AVE, BUILDING A STE 100, PLANO, TX 75074-5961
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
2344-A
TX
Other
Enumeration date
01/11/2007
Last updated
01/12/2012
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