Provider Demographics
NPI:1841743929
Name:SCOTT, TANIA EVA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:EVA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NORTH NORMA STREET
Mailing Address - Street 2:SUITE 127
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555
Mailing Address - Country:US
Mailing Address - Phone:760-446-1597
Mailing Address - Fax:760-499-9259
Practice Address - Street 1:1400 NORTH NORMA STREET
Practice Address - Street 2:SUITE 127
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555
Practice Address - Country:US
Practice Address - Phone:760-446-1597
Practice Address - Fax:760-499-9259
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health