Healthcare Provider Details

I. General information

NPI: 1598014748
Provider Name (Legal Business Name): KYLE MATTHEW FLAHERTY M.S., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 LONGFIELD CT
MONTGOMERY AL
36117-8055
US

IV. Provider business mailing address

1040 LONGFIELD CT
MONTGOMERY AL
36117-8055
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-9009
  • Fax: 334-288-9497
Mailing address:
  • Phone: 334-288-9009
  • Fax: 334-288-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC1966A
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3416
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: