Provider Demographics
NPI:1568734069
Name:SCOTT, TIMOTHY ALBERT
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALBERT
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 1:801 N MARKET AVE
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-2029
Mailing Address - Country:US
Mailing Address - Phone:580-623-8718
Mailing Address - Fax:
Practice Address - Street 1:311 W MAIN ST.
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OK
Practice Address - Zip Code:73724-0281
Practice Address - Country:US
Practice Address - Phone:580-515-1010
Practice Address - Fax:580-886-2339
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health