Provider Demographics
NPI:1073936944
Name:SCOTT, WILLIAM BENJAMIN JR
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:SCOTT
Suffix:JR
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 1:1240 W OWENS AVE
Mailing Address - Street 2:STE.3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2452
Mailing Address - Country:US
Mailing Address - Phone:702-877-9850
Mailing Address - Fax:702-877-9870
Practice Address - Street 1:1240 W OWENS AVE
Practice Address - Street 2:STE.3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2452
Practice Address - Country:US
Practice Address - Phone:702-877-9850
Practice Address - Fax:702-877-9870
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1249Medicaid