MEDICARE: STACY LYNN KEYSER MS,LPC-MH, NCC, QMHP

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	101YM0800X	Mental Health Counselor	LPCMH 20254	SD
2	101Y00000X	Counselor	7335	SD

General Provider Information

NPI Number	:	1497046387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY LYNN KEYSER MS,LPC-MH, NCC, QMHP

Provider Business Mailing Address
First Line	:	832 SAINT JOSEPH ST STE 204
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3168
Country	:	US
Telephone Number	:	605-299-9100
Fax Number	:	605-250-5159

Provider Business Practice Location Address
First Line	:	832 SAINT JOSEPH ST STE 204
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3168
Country	:	US
Telephone Number	:	605-299-9100
Fax Number	:	605-250-5159

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

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	12/21/2019

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