Healthcare Provider Details

I. General information

NPI: 1497046387
Provider Name (Legal Business Name): STACY LYNN KEYSER MS,LPC-MH, NCC, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 12/21/2019
Certification Date: 12/21/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 SAINT JOSEPH ST STE 204
RAPID CITY SD
57701-3168
US

IV. Provider business mailing address

832 SAINT JOSEPH ST STE 204
RAPID CITY SD
57701-3168
US

V. Phone/Fax

Practice location:
  • Phone: 605-299-9100
  • Fax: 605-250-5159
Mailing address:
  • Phone: 605-299-9100
  • Fax: 605-250-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7335
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCMH 20254
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: