Provider Demographics
NPI:1912208745
Name:SCOTT, LEZLY A (MA)
Entity Type:Individual
Prefix:
First Name:LEZLY
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LEZLY
Other - Middle Name:AMY
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2417 FAIRFIELD AVE
Mailing Address - Street 2:ATTN: LEZLY SCOTT
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-1210
Mailing Address - Country:US
Mailing Address - Phone:260-424-7977
Mailing Address - Fax:260-426-7576
Practice Address - Street 1:2417 FAIRFIELD AVE.
Practice Address - Street 2:ATTN: LEZLY SCOTT
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807
Practice Address - Country:US
Practice Address - Phone:260-424-7977
Practice Address - Fax:260-426-7576
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health