Provider Demographics
NPI:1437150216
Name:SCOTT, ANDREA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:C
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:C
Other - Last Name:SCOTT-FISHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:240 JENNIFER DR
Mailing Address - Street 2:STE 204
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4199
Mailing Address - Country:US
Mailing Address - Phone:928-649-2509
Mailing Address - Fax:928-646-8612
Practice Address - Street 1:240 JENNIFER DR
Practice Address - Street 2:STE 204
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4199
Practice Address - Country:US
Practice Address - Phone:928-649-2509
Practice Address - Fax:928-646-8612
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 15042084P0800X
AZLISAC - 09302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0612710OtherBCBS
AZ076704OtherAHCCCD
AZ0612710OtherBCBS
S26980Medicare UPIN