Provider Demographics
NPI:1457840324
Name:SCOTT, ALYSSA NICOLE (PSYD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MOCKINGBIRD LN APT 554
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3172
Mailing Address - Country:US
Mailing Address - Phone:828-707-6998
Mailing Address - Fax:
Practice Address - Street 1:114 E UNAKA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4624
Practice Address - Country:US
Practice Address - Phone:865-588-3173
Practice Address - Fax:865-244-3579
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3926103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical