Provider Demographics
NPI:1205029428
Name:SCOTT, MICHAELLE (CAS REGISTERED)
Entity Type:Individual
Prefix:
First Name:MICHAELLE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CAS REGISTERED
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 400637
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92340-0637
Mailing Address - Country:US
Mailing Address - Phone:760-244-5562
Mailing Address - Fax:
Practice Address - Street 1:200 E WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2842
Practice Address - Country:US
Practice Address - Phone:760-256-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)