Provider Demographics
NPI:1689435315
Name:SCOTT, MONDREA RENEE (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:MONDREA
Middle Name:RENEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:MRS
Other - First Name:MONDREA
Other - Middle Name:RENEE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC
Mailing Address - Street 1:1813 HARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3190
Mailing Address - Country:US
Mailing Address - Phone:817-601-8275
Mailing Address - Fax:817-345-7977
Practice Address - Street 1:1813 HARWOOD CT
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3190
Practice Address - Country:US
Practice Address - Phone:817-601-8275
Practice Address - Fax:817-345-7977
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16181101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)