Provider Demographics
NPI:1235501388
Name:WATERS, SCOTT J (LPC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:WATERS
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 1:465 72ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7237
Mailing Address - Country:US
Mailing Address - Phone:503-956-3719
Mailing Address - Fax:
Practice Address - Street 1:1600 VALLEY RIVER DR STE 103
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2141
Practice Address - Country:US
Practice Address - Phone:503-956-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4911101YP2500X
WAMHCA.MC.60501032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health