1184991614 NPI number — MS. CANDICE R. SCURRY LPC

Table of content: MS. CANDICE R. SCURRY LPC (NPI 1184991614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184991614 NPI number — MS. CANDICE R. SCURRY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCURRY
Provider First Name:
CANDICE
Provider Middle Name:
R.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCURRY
Provider Other First Name:
CANDICE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184991614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26611 GREY SPARROW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-3455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-641-7972
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 N AVONDALE RD # 352
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVONDALE ESTATES
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30002-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-588-5570
Provider Business Practice Location Address Fax Number:
832-218-4013
Provider Enumeration Date:
11/29/2011

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: 101Y00000X , with the licence number:  LPC008623 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: LPC008623 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 82171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LPC008623 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 82171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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