Healthcare Provider Details

I. General information

NPI: 1043078991
Provider Name (Legal Business Name): KECK COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 S 42ND ST STE 224
OMAHA NE
68105-2946
US

IV. Provider business mailing address

4923 DAVENPORT ST APT 2
OMAHA NE
68132-2985
US

V. Phone/Fax

Practice location:
  • Phone: 531-772-9749
  • Fax:
Mailing address:
  • Phone: 153-177-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMY KECK
Title or Position: OWNER, PROVIDER
Credential: PLADC
Phone: 153-177-2974