Provider Demographics
NPI:1659141307
Name:TABOR, SCOTT JOSEPH (LMCH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOSEPH
Last Name:TABOR
Suffix:
Gender:M
Credentials:LMCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 SW 89TH ST APT 1109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7744
Mailing Address - Country:US
Mailing Address - Phone:305-218-8315
Mailing Address - Fax:
Practice Address - Street 1:7350 SW 89TH ST APT 1109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7744
Practice Address - Country:US
Practice Address - Phone:305-218-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health