Provider Demographics
NPI:1629483037
Name:SCOTT, JEFFREY BRYAN
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRYAN
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 1:338 FALLING LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3969
Mailing Address - Country:US
Mailing Address - Phone:757-201-8010
Mailing Address - Fax:
Practice Address - Street 1:338 FALLING LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3969
Practice Address - Country:US
Practice Address - Phone:757-201-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst