Provider Demographics
NPI:1992262620
Name:KEITH, TANYA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ANN
Last Name:KEITH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1255
Mailing Address - Country:US
Mailing Address - Phone:402-658-7322
Mailing Address - Fax:
Practice Address - Street 1:809 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1255
Practice Address - Country:US
Practice Address - Phone:402-658-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063511041C0700X
3747P1801X
NE12601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant