Individual
MYSTIQUE LEIGH IMLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
603 W FLEEMAN STE 4, MANILA, AR 72442-9171
(870) 570-0358
(870) 570-0359
Mailing address
603 W FLEEMAN STE 4, MANILA, AR 72442-9171
(705) 700-3588
(870) 570-0359
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P1611172
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5CB23
BCBS
AR
Enumeration date
12/24/2014
Last updated
05/27/2020
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