Provider Demographics
NPI:1972884799
Name:SCOTT, PATRICIA RUTH
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RUTH
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-0856
Mailing Address - Country:US
Mailing Address - Phone:970-948-3770
Mailing Address - Fax:307-367-2166
Practice Address - Street 1:24 COUNTRY CLUB LANE
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:970-948-3770
Practice Address - Fax:307-367-2166
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
WY1492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program