Provider Demographics
NPI:1508957184
Name:SCOTT, BRIAN WAYNE (LPC/MHSP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WAYNE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E UNAKA AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4035
Mailing Address - Country:US
Mailing Address - Phone:423-926-3486
Mailing Address - Fax:
Practice Address - Street 1:600 E UNAKA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4035
Practice Address - Country:US
Practice Address - Phone:423-926-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional