Healthcare Provider Details

I. General information

NPI: 1811596992
Provider Name (Legal Business Name): STEPHEN KILLEN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTERVIEW DR STE 150
VESTAVIA HILLS AL
35216-3749
US

IV. Provider business mailing address

302 ROYAL OAKS DR
HOOVER AL
35244-2859
US

V. Phone/Fax

Practice location:
  • Phone: 205-807-5372
  • Fax: 205-413-8789
Mailing address:
  • Phone: 256-585-4586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4329
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: