Healthcare Provider Details

I. General information

NPI: 1881754620
Provider Name (Legal Business Name): GARY L. KECK MS, LIMHP, CPC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W 2ND ST
GRAND ISLAND NE
68801-5938
US

IV. Provider business mailing address

4918 MERRICK AVE
GRAND ISLAND NE
68801-9038
US

V. Phone/Fax

Practice location:
  • Phone: 308-379-4040
  • Fax:
Mailing address:
  • Phone: 308-381-2823
  • Fax: 308-385-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number433
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1903
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1108
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number691
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: