Provider Demographics
NPI:1487947115
Name:STAUCH, KEITH
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:STAUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 GALVIN RD S
Mailing Address - Street 2:208
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3712
Mailing Address - Country:US
Mailing Address - Phone:402-860-3405
Mailing Address - Fax:
Practice Address - Street 1:8610 BRENTWOOD DR
Practice Address - Street 2:1
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3377
Practice Address - Country:US
Practice Address - Phone:402-331-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor