MEDICARE: KENNETH A STREET LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2004	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004	OTHER	AL	LPC

General Provider Information

NPI Number	:	1023019932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH A STREET LPC

Provider Business Mailing Address
First Line	:	3413 RAINBOW PKWY STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3234
Country	:	US
Telephone Number	:	256-490-6423
Fax Number	:	256-380-5857

Provider Business Practice Location Address
First Line	:	3413 RAINBOW PKWY STE A
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-3234
Country	:	US
Telephone Number	:	256-490-6423
Fax Number	:	256-380-5857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/09/2025

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Directions to “ KENNETH A STREET LPC” Practice Location

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