Provider Demographics
NPI:1770221483
Name:SCOTT, DEVIN TAVARES
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:TAVARES
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33309 1ST WAY S STE A100
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6260
Mailing Address - Country:US
Mailing Address - Phone:509-398-7178
Mailing Address - Fax:
Practice Address - Street 1:33309 1ST WAY S STE A100
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6260
Practice Address - Country:US
Practice Address - Phone:509-398-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician