Provider Demographics
NPI:1518103621
Name:WORSHAM, SCOTT LEE (PHD, MED)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LEE
Last Name:WORSHAM
Suffix:
Gender:M
Credentials:PHD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 TAYLOR DRAPER LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3916
Mailing Address - Country:US
Mailing Address - Phone:512-343-8850
Mailing Address - Fax:512-343-8079
Practice Address - Street 1:11211 TAYLOR DRAPER LN
Practice Address - Street 2:SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3916
Practice Address - Country:US
Practice Address - Phone:512-343-8850
Practice Address - Fax:512-343-8079
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32474103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L8796Medicare PIN