Organization
IMAGINE CHANGE COUNSELING AND PSYCHOTHERAPY, PLLC
Active
Organization
IMAGINE CHANGE COUNSELING AND PSYCHOTHERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON JACOBSON LMSW (OWNER)
(424) 298-0560
Entity
Organization
Contact information
Practice address
1822 E BLUEFIELD AVE, PHOENIX, AZ 85022-1324
(424) 298-0560
Mailing address
1822 E BLUEFIELD AVE, PHOENIX, AZ 85022-1324
(424) 298-0560
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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