Provider Demographics
NPI:1093939597
Name:SCOTT, LYNN WIDDISON (MCOUN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:WIDDISON
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MCOUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-0481
Mailing Address - Country:US
Mailing Address - Phone:208-390-2177
Mailing Address - Fax:307-333-0515
Practice Address - Street 1:343 E 4TH N STE 204
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-6006
Practice Address - Country:US
Practice Address - Phone:208-390-2177
Practice Address - Fax:307-333-0515
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT 2906106H00000X
IDLMFT-6603106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist