MEDICARE: ELIZABETH B. LEE PHD

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	103TC0700X	Clinical Psychologist	2803	TN
2	103TC0700X	Clinical Psychologist	1863	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730338583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH B. LEE PHD

Provider Business Mailing Address
First Line	:	400 VESTAVIA PKWY
Second Line	:	SUITE 130
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3763
Country	:	US
Telephone Number	:	205-823-2373
Fax Number	:	205-823-2378

Provider Business Practice Location Address
First Line	:	400 VESTAVIA PKWY
Second Line	:	SUITE 130
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3763
Country	:	US
Telephone Number	:	205-823-2373
Fax Number	:	205-823-2378

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	02/04/2015

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Directions to “ ELIZABETH B. LEE PHD” Practice Location

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