Provider Demographics
NPI:1134861826
Name:SCOTT, KANISHA TERIA (LMSW)
Entity type:Individual
Prefix:
First Name:KANISHA
Middle Name:TERIA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KANISHA
Other - Middle Name:TERIA
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1111 HIGHWAY 6 STE 120
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4900
Mailing Address - Country:US
Mailing Address - Phone:281-769-2238
Mailing Address - Fax:769-216-4281
Practice Address - Street 1:1111 HIGHWAY 6 STE 120
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4900
Practice Address - Country:US
Practice Address - Phone:281-769-2238
Practice Address - Fax:769-216-4281
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1071911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical