Provider Demographics
NPI:1700257722
Name:SCOTT, DAVID JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6695
Mailing Address - Country:US
Mailing Address - Phone:702-291-7121
Mailing Address - Fax:702-947-6335
Practice Address - Street 1:4235 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6695
Practice Address - Country:US
Practice Address - Phone:702-291-7121
Practice Address - Fax:702-947-6335
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health