Provider Demographics
NPI:1548585474
Name:SCOTT, SANDRA LYNN (MFTI)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LYNN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21250 BOX SPRINGS RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8705
Mailing Address - Country:US
Mailing Address - Phone:951-686-1096
Mailing Address - Fax:
Practice Address - Street 1:21250 BOX SPRINGS RD
Practice Address - Street 2:SUITE 212
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8705
Practice Address - Country:US
Practice Address - Phone:951-686-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-04
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60658106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60658OtherBBS REGISTRATION NUMBER