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528 Kansas City St Ste 5 Rapid City SD 57701-5037 | |
| (605) 299-9100 | |
| (605) 250-5159 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 528 Kansas City St Ste 5, Rapid City, South Dakota |
| Authorized Official Name and Position | Stacy Lynn Keyser (OWNER, PRESIDENT) |
| Authorized Official Contact | 6054314151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
528 Kansas City St Ste 5 Rapid City SD 57701-5037 Ph: (605) 299-9100 | 528 Kansas City St Ste 5 Rapid City SD 57701-5037 Ph: (605) 299-9100 |
| NPI Number | 1780058487 |
|---|---|
| Provider Enumeration Date | 11/18/2015 |
| Last Update Date | 06/29/2023 |
| Certification Date | 09/07/2021 |
| Medicare PECOS PAC ID | 9739520883 |
|---|---|
| Medicare Enrollment ID | O20240507004069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780058487 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 20254 (South Dakota) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | 20254 (South Dakota) | Primary |
| Provider Name | Stacy Lynn Keyser |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497046387 PECOS PAC ID: 0648611798 Enrollment ID: I20240507004152 |
| Provider Name | Elizabeth K Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679803654 PECOS PAC ID: 5597155846 Enrollment ID: I20240822000444 |
| Provider Name | Mary Artichoker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164201042 PECOS PAC ID: 3971042896 Enrollment ID: I20240823000413 |
| Provider Name | Mary Schweitzer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003593229 PECOS PAC ID: 0840739165 Enrollment ID: I20240829003094 |
| Provider Name | Silver G See |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376166520 PECOS PAC ID: 5991244253 Enrollment ID: I20240829004684 |
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