Provider Demographics
NPI:1588750459
Name:LAURELTREE FAMILY & ACADEMIC COUNSELING SERVICES INC
Entity type:Organization
Organization Name:LAURELTREE FAMILY & ACADEMIC COUNSELING SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LPC, MA
Authorized Official - Phone:256-677-1092
Mailing Address - Street 1:1947 PINE LAKE DR NW
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-4535
Mailing Address - Country:US
Mailing Address - Phone:256-677-1092
Mailing Address - Fax:256-586-6715
Practice Address - Street 1:1058 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-7000
Practice Address - Country:US
Practice Address - Phone:256-677-1092
Practice Address - Fax:256-586-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ835Medicare UPIN