Provider Demographics
NPI:1689914335
Name:SCOTT, TAMIKA (MS, ABA, QMHA, QIDP)
Entity Type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS, ABA, QMHA, QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-1115
Mailing Address - Country:US
Mailing Address - Phone:702-245-2876
Mailing Address - Fax:
Practice Address - Street 1:450 E MILLS AVE APT 7
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4415
Practice Address - Country:US
Practice Address - Phone:702-245-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst