Provider Demographics
NPI:1558058800
Name:SCOTT, RICHARD GEORGE
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GEORGE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1272
Mailing Address - Country:US
Mailing Address - Phone:385-324-6838
Mailing Address - Fax:
Practice Address - Street 1:375 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1272
Practice Address - Country:US
Practice Address - Phone:385-324-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health