Provider Demographics
NPI:1649204702
Name:SCOTT, MONTE LANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:LANE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18303 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-5429
Mailing Address - Country:US
Mailing Address - Phone:206-719-0813
Mailing Address - Fax:
Practice Address - Street 1:18303 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5429
Practice Address - Country:US
Practice Address - Phone:206-719-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8855534Medicare ID - Type Unspecified