Provider Demographics
NPI:1497046387
Name:KEYSER, STACY LYNN (MS,LPC-MH, NCC, QMHP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:KEYSER
Suffix:
Gender:F
Credentials:MS,LPC-MH, NCC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 SAINT JOSEPH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3168
Mailing Address - Country:US
Mailing Address - Phone:605-299-9100
Mailing Address - Fax:605-250-5159
Practice Address - Street 1:832 SAINT JOSEPH ST STE 204
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3168
Practice Address - Country:US
Practice Address - Phone:605-299-9100
Practice Address - Fax:605-250-5159
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH 20254101YM0800X
SD7335101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD473293628OtherEIN