Provider Demographics
NPI:1073115309
Name:SCOTT, DAVID ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:SCOTT
Suffix:
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 1:360 MONTE VISTA AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4556
Mailing Address - Country:US
Mailing Address - Phone:916-917-0813
Mailing Address - Fax:
Practice Address - Street 1:360 MONTE VISTA AVE APT 205
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4556
Practice Address - Country:US
Practice Address - Phone:916-917-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor