Provider Demographics
NPI:1891186177
Name:SCOTT, MALYNDA K (ACMHC)
Entity Type:Individual
Prefix:
First Name:MALYNDA
Middle Name:K
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 S DIAMOND RANCH PKWY W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3020
Mailing Address - Country:US
Mailing Address - Phone:435-635-4297
Mailing Address - Fax:
Practice Address - Street 1:433 S DIAMOND RANCH PKWY W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3020
Practice Address - Country:US
Practice Address - Phone:435-635-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9485621-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT260022408OtherRAILROAD MEDICARE
UT876000308007Medicaid
UT000055266Medicare PIN