Healthcare Provider Details

I. General information

NPI: 1497453898
Provider Name (Legal Business Name): BRIAN PATRICK KANE JR. MA, ALC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 KATHY LN SW STE 102
DECATUR AL
35603-1026
US

IV. Provider business mailing address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

V. Phone/Fax

Practice location:
  • Phone: 256-701-5651
  • Fax: 256-429-9411
Mailing address:
  • Phone: 256-975-4291
  • Fax: 256-325-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC04412
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5511
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: