Provider Demographics
NPI:1013220037
Name:MACOMBER, SCOT R (LPC)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:R
Last Name:MACOMBER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 DUNLAVY LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1522
Mailing Address - Country:US
Mailing Address - Phone:832-656-1442
Mailing Address - Fax:
Practice Address - Street 1:620 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3776
Practice Address - Country:US
Practice Address - Phone:281-299-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional