Healthcare Provider Details

I. General information

NPI: 1487947115
Provider Name (Legal Business Name): KEITH STAUCH LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 S COUNTY TRL UNIT 107
EAST GREENWICH RI
02818-1771
US

IV. Provider business mailing address

1301 GALVIN RD S APT 208
BELLEVUE NE
68005-3714
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0040
  • Fax:
Mailing address:
  • Phone: 402-860-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01198
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: