Provider Demographics
NPI:1578962023
Name:SCOTT, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:11479 PINE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7308
Mailing Address - Country:US
Mailing Address - Phone:303-854-9760
Mailing Address - Fax:844-270-2223
Practice Address - Street 1:11479 PINE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7308
Practice Address - Country:US
Practice Address - Phone:303-854-9760
Practice Address - Fax:844-270-2223
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0104722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health