Provider Demographics
NPI:1437241684
Name:SCOTT, QUIBALLAH EFAY (BA)
Entity Type:Individual
Prefix:MS
First Name:QUIBALLAH
Middle Name:EFAY
Last Name:SCOTT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 LOMA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1745 W ORANGEWOOD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2004
Practice Address - Country:US
Practice Address - Phone:714-221-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health