Provider Demographics
NPI:1346563699
Name:ACUS, DAVID SCOTT (MA, MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:ACUS
Suffix:
Gender:M
Credentials:MA, MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1603
Mailing Address - Country:US
Mailing Address - Phone:419-636-1713
Mailing Address - Fax:888-276-4914
Practice Address - Street 1:108 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1603
Practice Address - Country:US
Practice Address - Phone:419-636-1713
Practice Address - Fax:888-276-4914
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00303381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2713933Medicaid