Provider Demographics
NPI:1164676706
Name:CASSIDY, SCOTT BOSSEN (LPC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:BOSSEN
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 WINDCHIME PL STE 303
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1933
Mailing Address - Country:US
Mailing Address - Phone:719-357-7313
Mailing Address - Fax:
Practice Address - Street 1:487 WINDCHIME PL STE 303
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1933
Practice Address - Country:US
Practice Address - Phone:719-357-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional