Provider Demographics
NPI:1124548359
Name:SCOTT, WILLIAM SPENCER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SPENCER
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 S CANFIELD AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4353
Mailing Address - Country:US
Mailing Address - Phone:323-999-1395
Mailing Address - Fax:
Practice Address - Street 1:2510 MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3581
Practice Address - Country:US
Practice Address - Phone:323-999-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical