Provider Demographics
NPI:1326511809
Name:SCOTT, EDWARD REUBEN (CADC I)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:REUBEN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33184 FUCHSIA LN
Mailing Address - Street 2:
Mailing Address - City:TANGENT
Mailing Address - State:OR
Mailing Address - Zip Code:97389-1100
Mailing Address - Country:US
Mailing Address - Phone:541-730-2167
Mailing Address - Fax:800-549-1017
Practice Address - Street 1:1760 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1725
Practice Address - Country:US
Practice Address - Phone:541-730-2167
Practice Address - Fax:800-549-1017
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-09-44101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)