Provider Demographics
NPI:1871817809
Name:SCOTT, MAGNUS WT
Entity Type:Individual
Prefix:MR
First Name:MAGNUS
Middle Name:WT
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:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:LANGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73050-0538
Mailing Address - Country:US
Mailing Address - Phone:405-361-9619
Mailing Address - Fax:
Practice Address - Street 1:313 TOLSON STREET
Practice Address - Street 2:
Practice Address - City:LANGSTON
Practice Address - State:OK
Practice Address - Zip Code:73050-0538
Practice Address - Country:US
Practice Address - Phone:405-361-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health