| Imagine Life, Llc | |
|
360 Central Ave Ste 800 Saint Petersburg FL 33701-3984 | |
| (727) 939-5037 | |
| Not Available |
| Full Name | Imagine Life, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 360 Central Ave Ste 800, Saint Petersburg, Florida |
| Authorized Official Name and Position | Amanda Pratt (OWNER/ THERAPIST) |
| Authorized Official Contact | 7279395037 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imagine Life, Llc 360 Central Ave Ste 800 Saint Petersburg FL 33701-3984 Ph: (727) 939-5037 | Imagine Life, Llc 360 Central Ave Ste 800 Saint Petersburg FL 33701-3984 Ph: (727) 939-5037 |
| NPI Number | 1467928390 |
|---|---|
| Provider Enumeration Date | 10/18/2018 |
| Last Update Date | 01/27/2022 |
| Certification Date | 01/27/2022 |
| Medicare PECOS PAC ID | 7416292008 |
|---|---|
| Medicare Enrollment ID | O20190102000021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467928390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Amanda Pratt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548782725 PECOS PAC ID: 8325383912 Enrollment ID: I20190102000054 |
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