Provider Demographics
NPI:1497128532
Name:SCOTT, COREY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-8181
Mailing Address - Country:US
Mailing Address - Phone:703-732-8254
Mailing Address - Fax:
Practice Address - Street 1:106 FACULTY ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7316
Practice Address - Country:US
Practice Address - Phone:980-785-1113
Practice Address - Fax:980-785-1114
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA0134000068103K00000X
VA0133000804103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0133000804OtherLICENSED BEHAVIOR ANALYST
1-16-22719OtherBCBA
VA1825Medicaid