Provider Demographics
NPI:1063496487
Name:SYMES, SCOTT J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:SYMES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 NE RALPH POWELL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2368
Mailing Address - Country:US
Mailing Address - Phone:816-246-0111
Mailing Address - Fax:866-335-7993
Practice Address - Street 1:3367 NE RALPH POWELL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2368
Practice Address - Country:US
Practice Address - Phone:816-246-0111
Practice Address - Fax:866-335-7993
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004013232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495979718Medicaid
MOQ19771Medicare UPIN
MOL43D186Medicare ID - Type Unspecified