Provider Demographics
NPI:1558767327
Name:SCOTT, GEORGE (MS, ICAC-I)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MS, ICAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-3404
Mailing Address - Country:US
Mailing Address - Phone:260-481-2900
Mailing Address - Fax:260-481-2709
Practice Address - Street 1:909 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-3404
Practice Address - Country:US
Practice Address - Phone:260-481-2900
Practice Address - Fax:260-481-2709
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health