Provider Demographics
NPI:1114119211
Name:SCOTT, TERRENCE D (MA, LPC, LCDC, LBSW)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MA, LPC, LCDC, LBSW
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 690922
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-0922
Mailing Address - Country:US
Mailing Address - Phone:832-528-1999
Mailing Address - Fax:
Practice Address - Street 1:525 N SAM HOUSTON PKWY E
Practice Address - Street 2:597
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4037
Practice Address - Country:US
Practice Address - Phone:832-528-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67001101YP2500X, 102L00000X
TX10252101YA0400X
TX36555104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1845158Medicaid