Provider Demographics
NPI:1407474059
Name:SCOTT, SHARIE DIANE
Entity Type:Individual
Prefix:MRS
First Name:SHARIE
Middle Name:DIANE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19915 CRESTED PEAK LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3985
Mailing Address - Country:US
Mailing Address - Phone:762-233-5463
Mailing Address - Fax:
Practice Address - Street 1:19915 CRESTED PEAK LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3985
Practice Address - Country:US
Practice Address - Phone:762-233-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional