Mystique Leigh Imler, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P1611172 Issued in AR

Practice address

603 W Fleeman Ste 4
Manila, AR 72442-9171

Phone

(870) 570-0358

Fax

(870) 570-0359

NPI assigned

Dec 24, 2014

Last updated

May 27, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Delta Behavioral Health, LLCGroup PAC ID 6406280007, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Delta Behavioral Health, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Manila, AR
  • NPI 1720637085
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1419379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590537600000",
    "number": "1467840538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 W FLEEMAN STE 4",
            "city": "MANILA",
            "state": "AR",
            "postal_code": "724429171",
            "telephone_number": "705-700-3588",
            "fax_number": "870-570-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 W FLEEMAN STE 4",
            "city": "MANILA",
            "state": "AR",
            "postal_code": "724429171",
            "telephone_number": "870-570-0358",
            "fax_number": "870-570-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMLER",
        "first_name": "MYSTIQUE",
        "middle_name": "LEIGH",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-24",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1611172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5CB23",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Manila, AR
• Providers in Manila, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.