1427229004 NPI number — MS. STEPHANIE SCRUGGS LICDC-CS, LMT

Table of content: MS. STEPHANIE SCRUGGS LICDC-CS, LMT (NPI 1427229004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427229004 NPI number — MS. STEPHANIE SCRUGGS LICDC-CS, LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCRUGGS
Provider First Name:
STEPHANIE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICDC-CS, LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELMS
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICDC-CS, LMT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427229004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3021 VERNON PLACE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219-2417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-541-7099
Provider Business Mailing Address Fax Number:
513-541-0989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41011-2422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-491-6672
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2008

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: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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