Keely Imboden, is a medicare enrolled "Counselor - Professional" provider in Harrisburg, Arkansas. Her current practice location is
1103 N Illinois St Ste B, Harrisburg, Arkansas. You can reach out to her office (for appointments etc.) via phone at
(870) 931-8412.
Keely Imboden is licensed to practice in NU (license number ) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1962157487.
Healthcare Provider's Profile
| Full Name | Keely Imboden |
|---|
| Gender | Female |
|---|
| Speciality | Counselor - Professional |
|---|
| Location | 1103 N Illinois St Ste B, Harrisburg, Arkansas |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1962157487
- Provider Enumeration Date: 02/14/2022
- Last Update Date: 05/20/2025
Medicare PECOS Information:
- PECOS PAC ID: 9739600495
- Enrollment ID: I20250311000338
Medical Identifiers
Medical identifiers for Keely Imboden such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1962157487 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | A2208025 (Arkansas) | Secondary |
| 101YP2500X | Counselor - Professional | (NU) | Primary |
| 171M00000X | Case Manager/care Coordinator | (NU) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Keely Imboden allows following entities to bill medicare on her behalf.
| Entity Name | Changes Behavioral Health, LLC |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1114260486
PECOS PAC ID: 6103149653
Enrollment ID: O20150108001118 |
|---|
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Keely Imboden is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Keely Imboden,
1103 N Illinois St Ste B,
Harrisburg, AR 72432-3023
Ph: (870) 931-8412 | Keely Imboden,
1103 N Illinois St Ste B,
Harrisburg, AR 72432-3023
Ph: (870) 931-8412 |
Reviews and Comments