Provider Demographics
NPI:1972824415
Name:SCOTT, CHERYL ANDREA (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANDREA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 PADRE COURT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5821
Mailing Address - Country:US
Mailing Address - Phone:682-459-3094
Mailing Address - Fax:817-423-7384
Practice Address - Street 1:4421 PADRE COURT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5821
Practice Address - Country:US
Practice Address - Phone:682-459-3094
Practice Address - Fax:817-423-7384
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC 12101YP2500X
TX80319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12433222OtherCAQH
TX3962599Medicaid