Provider Demographics
NPI:1518386275
Name:SCOTT, CARRIE THOMAS (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE THOMAS
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-1121
Mailing Address - Country:US
Mailing Address - Phone:208-721-0531
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE 302A
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8402
Practice Address - Country:US
Practice Address - Phone:208-721-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional