Provider Demographics
NPI:1891737029
Name:ANSTADT, SCOTT P (LSCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:P
Last Name:ANSTADT
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3632
Mailing Address - Country:US
Mailing Address - Phone:785-408-9611
Mailing Address - Fax:
Practice Address - Street 1:114 E 15TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3632
Practice Address - Country:US
Practice Address - Phone:785-408-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 36601041C0700X
KSRAODAC 137101YA0400X
AZLISAC-10175101YA0400X
AZLCSW-102181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ725129Medicaid
AZ108303Medicare ID - Type Unspecified