Provider Demographics
NPI:1053662387
Name:STANTON, SCOTT C (MDIV, BCC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:STANTON
Suffix:
Gender:M
Credentials:MDIV, BCC
Other - Prefix:
Other - First Name:S.
Other - Middle Name:CHRISTOPHER
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDIV, BCC
Mailing Address - Street 1:650 E EDEN CT
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8512
Mailing Address - Country:US
Mailing Address - Phone:907-775-2046
Mailing Address - Fax:907-357-9693
Practice Address - Street 1:650 E EDEN CT
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8512
Practice Address - Country:US
Practice Address - Phone:907-775-2046
Practice Address - Fax:907-357-9693
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral