Provider Demographics
NPI:1073275079
Name:NORTHWAY, SCOUT (MA)
Entity Type:Individual
Prefix:
First Name:SCOUT
Middle Name:
Last Name:NORTHWAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 SE MOUNT HOOD HWY APT 231
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7109
Mailing Address - Country:US
Mailing Address - Phone:503-833-2846
Mailing Address - Fax:
Practice Address - Street 1:765 SE MOUNT HOOD HWY APT 231
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-7109
Practice Address - Country:US
Practice Address - Phone:503-833-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional