Provider Demographics
NPI:1225712375
Name:SCOTT, CALVIN LEONARD
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:LEONARD
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 FASOLA RD APT 1
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-6853
Mailing Address - Country:US
Mailing Address - Phone:404-885-6318
Mailing Address - Fax:
Practice Address - Street 1:4645 BELL ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-1923
Practice Address - Country:US
Practice Address - Phone:360-643-0034
Practice Address - Fax:360-208-0665
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician