Provider Demographics
NPI:1184437121
Name:BRAXTON, KEITH DESHAWN (LPC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DESHAWN
Last Name:BRAXTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-3814
Mailing Address - Country:US
Mailing Address - Phone:773-896-6156
Mailing Address - Fax:
Practice Address - Street 1:8116 3RD AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-3814
Practice Address - Country:US
Practice Address - Phone:773-896-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL04237101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional