Provider Demographics
NPI:1962636860
Name:SCOTT CABOT WILLIS, PHD PC
Entity Type:Organization
Organization Name:SCOTT CABOT WILLIS, PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CABOT
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-547-9505
Mailing Address - Street 1:7157 SW BEVELAND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9628
Mailing Address - Country:US
Mailing Address - Phone:503-547-9505
Mailing Address - Fax:
Practice Address - Street 1:7157 SW BEVELAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-9628
Practice Address - Country:US
Practice Address - Phone:503-547-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty