Provider Demographics
NPI:1285197541
Name:FOURNIER, SCOTT WARD (LCMHC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WARD
Last Name:FOURNIER
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 DARLING HILL RD
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-4515
Mailing Address - Country:US
Mailing Address - Phone:802-473-6107
Mailing Address - Fax:
Practice Address - Street 1:1129 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2601
Practice Address - Country:US
Practice Address - Phone:802-473-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty