Provider Demographics
NPI:1033977798
Name:SCOTT, TANISHA CHANTEL (LBS)
Entity Type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:CHANTEL
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OFFICE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3219
Mailing Address - Country:US
Mailing Address - Phone:570-391-2309
Mailing Address - Fax:
Practice Address - Street 1:500 OFFICE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3234
Practice Address - Country:US
Practice Address - Phone:570-391-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006714106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst