Provider Demographics
NPI:1093705758
Name:SCOTT, MARY SUE (NCC, LMFT, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY SUE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NCC, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2328
Mailing Address - Country:US
Mailing Address - Phone:276-223-4443
Mailing Address - Fax:276-223-0133
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2328
Practice Address - Country:US
Practice Address - Phone:276-223-4443
Practice Address - Fax:276-223-0133
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001401101YP2500X
VA0717000805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA039925OtherVALUE OPTIONS; OPTIONS
VA067693OtherANTHEM BC BS
VA343689OtherTRICARE GROUP
VA134663 INDIVIDUALOtherTRICARE
VA222129OtherPHCS
VA5401232Medicaid
VA132272OtherMHN
VA5409764Medicaid
VA58358-76512OtherUBH
VA249565OtherCOMPSYCH
VA74189-76512OtherUBH
VA7805017OtherAETNA BEHAVIORAL HEALTH
VA8202-38109926OtherAETNA/USHC
VA423453OtherMAMSI; MDIPA
VAO-86315OtherSENTARA; QUALCHOICE
VA2237697OtherCIGNA
VA5401232OtherVIRGINIA PREMIER