Provider Demographics
NPI:1487643896
Name:SCOTT, DONALD STUART (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:STUART
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 FAR HILLS AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2380
Mailing Address - Country:US
Mailing Address - Phone:937-438-7580
Mailing Address - Fax:937-438-3351
Practice Address - Street 1:5335 FAR HILLS AVE STE 221
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2380
Practice Address - Country:US
Practice Address - Phone:937-438-7580
Practice Address - Fax:937-438-3351
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3149103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S08510Medicare UPIN