Provider Demographics
NPI:1881196475
Name:SCOTT, MIA LUCA (BSW, QMHA)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:LUCA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:BSW, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1548
Mailing Address - Country:US
Mailing Address - Phone:503-252-3304
Mailing Address - Fax:
Practice Address - Street 1:7621 N PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5953
Practice Address - Country:US
Practice Address - Phone:503-240-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)