Provider Demographics
NPI:1376897934
Name:SCOTT, CAROLYN ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N PARSONS AVE
Mailing Address - Street 2:SUITE 107A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4538
Mailing Address - Country:US
Mailing Address - Phone:813-833-2436
Mailing Address - Fax:
Practice Address - Street 1:13805 SKY MEADOWS LN
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-6133
Practice Address - Country:US
Practice Address - Phone:813-833-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health