MEDICARE: KELLY LYNN IMEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	APC002043	PA
2	101YM0800X	Mental Health Counselor	APC002043	PA

General Provider Information

NPI Number	:	1346107430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNN IMEL

Provider Business Mailing Address
First Line	:	1111 LIBERTY ST
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-7747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 WESTVIEW DR
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-1241
Country	:	US
Telephone Number	:	724-461-5816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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