Provider Demographics
NPI:1598014748
Name:FLAHERTY, KYLE MATTHEW (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:MATTHEW
Last Name:FLAHERTY
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 LONGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8055
Mailing Address - Country:US
Mailing Address - Phone:334-288-9009
Mailing Address - Fax:334-288-9497
Practice Address - Street 1:1040 LONGFIELD CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8055
Practice Address - Country:US
Practice Address - Phone:334-288-9009
Practice Address - Fax:334-288-9497
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1966A101Y00000X
AL3416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor