=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801030614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA EDWARDS KEANE LPC, RPT, NBCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2009
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 OFFICE PARK CIR STE 313
-----------------------------------------------------
City | MOUNTAIN BRK
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35223-2695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-291-8169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2420 WOODMERE DR
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35226-3531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 2689
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------