Provider Demographics
NPI:1558961169
Name:SCOTT, MICHAEL DONALD (COUNSELOR, MINISTER)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DONALD
Last Name:SCOTT
Suffix:
Gender:M
Credentials:COUNSELOR, MINISTER
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 1030
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:OK
Mailing Address - Zip Code:73028-1030
Mailing Address - Country:US
Mailing Address - Phone:405-326-7936
Mailing Address - Fax:
Practice Address - Street 1:204 N SHANNON WAY
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-2350
Practice Address - Country:US
Practice Address - Phone:405-326-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty