1083264501 NPI number — MRS. DAZHONI ELIZABETH SCOTT LPC, CRC

Table of content: MRS. DAZHONI ELIZABETH SCOTT LPC, CRC (NPI 1083264501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083264501 NPI number — MRS. DAZHONI ELIZABETH SCOTT LPC, CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
DAZHONI
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083264501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 E. CEDAR AVENUE #26
Provider Second Line Business Mailing Address:
2110 N. EAST ST APT C
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-890-8829
Provider Business Mailing Address Fax Number:
928-773-1245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E. CEDAR AVENUE #26
Provider Second Line Business Practice Location Address:
2110 N. EAST ST APT C
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-773-1245
Provider Business Practice Location Address Fax Number:
928-773-1245
Provider Enumeration Date:
09/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  18310 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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