Provider Demographics
NPI:1366822702
Name:SCOTT, DAMEN
Entity Type:Individual
Prefix:
First Name:DAMEN
Middle Name:
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 1:4880 E BONANZA RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3469
Mailing Address - Country:US
Mailing Address - Phone:702-489-8172
Mailing Address - Fax:702-998-1583
Practice Address - Street 1:4880 E BONANZA RD
Practice Address - Street 2:SUITE 9
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3469
Practice Address - Country:US
Practice Address - Phone:702-489-8172
Practice Address - Fax:702-998-1583
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst