Provider Demographics
NPI:1104669225
Name:BRAZIL, KATHRYN LANE (MS)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LANE
Last Name:BRAZIL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LANE
Other - Last Name:BRAZIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:11194 KNOX LNDG
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-8703
Mailing Address - Country:US
Mailing Address - Phone:251-233-9345
Mailing Address - Fax:
Practice Address - Street 1:3929 AIRPORT BLVD STE 2-204
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2241
Practice Address - Country:US
Practice Address - Phone:251-480-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health