Keely Imboden

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

1103 N Illinois St Ste B
Harrisburg, AR 72432-3023

Phone

(870) 931-8412

NPI assigned

Feb 14, 2022

Last updated

May 20, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Keely Maynard Former name

Electronic endpoints 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

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.

• Changes Behavioral Health, LLC

  • Community/Behavioral Health Agency
  • Wynne, AR
  • NPI 1114260486
  Medicare reassignment NPD
• 1821 Counseling LLC

  • Professional Counselor
  • Harrisburg, AR
  • NPI 1033900113
  NPD

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

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1962157487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 N ILLINOIS ST STE B",
            "city": "HARRISBURG",
            "state": "AR",
            "postal_code": "724323023",
            "telephone_number": "870-931-8412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 N ILLINOIS ST STE B",
            "city": "HARRISBURG",
            "state": "AR",
            "postal_code": "724323023",
            "telephone_number": "870-931-8412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "204 Mississippi St S",
            "address_purpose": "LOCATION",
            "city": "Wynne",
            "state": "AR",
            "postal_code": "723963025",
            "country_code": "US",
            "telephone_number": "870-208-8499",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2707 Browns Ln",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724017213",
            "country_code": "US",
            "telephone_number": "870-972-4050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMBODEN",
        "first_name": "KEELY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-14",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A2208025",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kimboden@changesbehavioralhealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "unknown",
            "address_1": "204 Mississippi St S",
            "city": "Wynne",
            "state": "AR",
            "country_code": "US",
            "postal_code": "723963025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KEELY",
            "last_name": "MAYNARD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Harrisburg Family Pharmacy (Harrisburg Clinic Pharmacy)
• Harrisburg School District
• Lana Headley, APN
• Vonda Gale Houchin, MD
• Joni Croom Hutton, M.S.P. CCC/SLP
• Natalie Kristene Jackson, CCC-SLP
• Pierce Jackson, PTA
• Let's Talk Therapy LLC
• Lifeline Paramedics Inc
• Wanda Kay Linebarger, APN

• Professional Counselor in Harrisburg, AR
• Providers in Harrisburg, 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 20, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.