1669516266 NPI number — MR. ROBERT L SCOTT LMFT

Table of content: MR. ROBERT L SCOTT LMFT (NPI 1669516266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669516266 NPI number — MR. ROBERT L SCOTT LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
ROBERT
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCOTT
Provider Other First Name:
BOBBY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669516266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 GOODMAN RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
OLIVE BRANCH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38654-7002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-893-6556
Provider Business Mailing Address Fax Number:
662-893-1102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 GOODMAN ROAD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OLIVE BRANCH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-893-6556
Provider Business Practice Location Address Fax Number:
662-893-1102
Provider Enumeration Date:
02/16/2007

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: 101YA0400X , with the licence number:  AD04-038S , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: TO158 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 4060799 . This is a "BLUE CROSS BLUE SHIELD TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0007541221 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 497541 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 215522 . This is a "COMPSYCHE" identifier . This identifiers is of the category "OTHER".




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