Provider Demographics
NPI:1629500038
Name:SCOTT, EVAN (BCBA)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22859 MORRO DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4748
Mailing Address - Country:US
Mailing Address - Phone:415-999-3445
Mailing Address - Fax:
Practice Address - Street 1:1111 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7646
Practice Address - Country:US
Practice Address - Phone:323-796-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-25402103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst