Provider Demographics
NPI:1760071542
Name:STAAB, KEELIN (PLPC)
Entity Type:Individual
Prefix:
First Name:KEELIN
Middle Name:
Last Name:STAAB
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:KEELIN
Other - Middle Name:
Other - Last Name:VALENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1952
Mailing Address - Country:US
Mailing Address - Phone:636-931-2700
Mailing Address - Fax:636-931-5304
Practice Address - Street 1:200 SENN THOMAS DR
Practice Address - Street 2:
Practice Address - City:HERCULANEUM
Practice Address - State:MO
Practice Address - Zip Code:63048-1033
Practice Address - Country:US
Practice Address - Phone:636-931-2700
Practice Address - Fax:636-931-5304
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021014949101YM0800X, 101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator