Provider Demographics
NPI:1902944580
Name:TAUBOLD, SCOTT MATTHEW (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MATTHEW
Last Name:TAUBOLD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 S FRANKLIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5456
Mailing Address - Country:US
Mailing Address - Phone:707-961-2669
Mailing Address - Fax:707-961-2698
Practice Address - Street 1:347 CYPRESS ST STE B
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5458
Practice Address - Country:US
Practice Address - Phone:707-964-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20805103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist