Provider Demographics
NPI:1851377600
Name:SCOTT, JUDITH
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
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 1:4149 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3087
Mailing Address - Country:US
Mailing Address - Phone:816-531-6030
Mailing Address - Fax:913-648-4799
Practice Address - Street 1:4149 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3087
Practice Address - Country:US
Practice Address - Phone:816-531-6030
Practice Address - Fax:913-648-4799
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS001798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health