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General NPI Number Information
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NPI Number | 1952281115
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Entity Type | Individual
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Provider Name | BRANDON D LACKEY APC
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Gender | Male
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Dates
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Enumeration Date | 09/06/2025
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Last Update Date | 09/06/2025
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Provider Practice Location Address
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Address Line | 1804 6TH AVE N
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City | BESSEMER
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State | AL
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Zip | 35020-4851
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Country | US
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Telephone | 205-428-8449
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 MONTREAT LN APT D
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City | VESTAVIA HILLS
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State | AL
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Zip | 35216-4023
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Country | US
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Telephone | 205-533-0760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ALC05717
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License Number State | AL
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