Provider Demographics
NPI:1477921450
Name:SCOTT, HALEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:HALEIGH
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9311 DEFIANCE CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1011
Mailing Address - Country:US
Mailing Address - Phone:330-317-9274
Mailing Address - Fax:
Practice Address - Street 1:2717 COTTAGE WAY STE 16&17
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1232
Practice Address - Country:US
Practice Address - Phone:169-913-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30797103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid