Provider Demographics
NPI:1922681311
Name:SCANLON, NATALIE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:MARIE
Last Name:SCANLON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 SUN GLIDE LN
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3779
Mailing Address - Country:US
Mailing Address - Phone:507-421-2474
Mailing Address - Fax:
Practice Address - Street 1:7700 CAT HOLLOW DR STE 206
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5799
Practice Address - Country:US
Practice Address - Phone:845-780-7512
Practice Address - Fax:501-225-9512
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3701-57103T00000X
TX38883103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty