=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336369883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURALEE GRACE ESTES MED., MDIV.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 04/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1675 MONTCLAIR RD EASTWOOD BUILDING, SUITE 252
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35210-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-588-6347
-----------------------------------------------------
Fax | 205-588-6384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1675 MONTCLAIR RD EASTWOOD BUILDING, SUITE 252
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35210-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-588-6347
-----------------------------------------------------
Fax | 205-588-6384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number | 4539
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | #177
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------