Healthcare Provider Details

I. General information

NPI: 1619831906
Provider Name (Legal Business Name): MALEHA MCKINZY LARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERIMETER PARK S STE 100N
BIRMINGHAM AL
35243-3248
US

IV. Provider business mailing address

1 PERIMETER PARK S STE 100N
BIRMINGHAM AL
35243-3248
US

V. Phone/Fax

Practice location:
  • Phone: 205-936-2356
  • Fax: 205-273-5033
Mailing address:
  • Phone: 205-936-2356
  • Fax: 205-273-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC05777
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: