Provider Demographics
NPI:1760998967
Name:SCOVILL, KATY MICHELLE (BA, RBT)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:MICHELLE
Last Name:SCOVILL
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:CALKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:451 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1422
Mailing Address - Country:US
Mailing Address - Phone:720-539-7428
Mailing Address - Fax:
Practice Address - Street 1:451 21ST AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1422
Practice Address - Country:US
Practice Address - Phone:720-539-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17-37647106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician