Provider Demographics
NPI:1518147321
Name:KETRING, SCOTT A (PHD)
Entity Type:Individual
Prefix:PROF
First Name:SCOTT
Middle Name:A
Last Name:KETRING
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 1:308 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5923
Mailing Address - Country:US
Mailing Address - Phone:334-887-6101
Mailing Address - Fax:334-844-1924
Practice Address - Street 1:MARRIAGE AND FAMILY THERAPY CENTER
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849-0001
Practice Address - Country:US
Practice Address - Phone:334-844-4479
Practice Address - Fax:334-844-1924
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL206106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist